NPIMap

Organization Active NPI

Pediatric Dentistry & Orthodontics of VA, PC

  • General Practice Dentistry
  • Midlothian, VA
National Provider Identifier
1124579396
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC
Practice address
13463 Hull Street Rd.
Midlothian, VA 23112-2103
Phone
(804) 739-0963
Fax
(804) 739-0965
NPI assigned
Oct 21, 2016
Organization subpart
Yes
Parent organization
CENTRAL VIRGINIA DENTAL CARE, P.L.C.-PEDIATRIC DENTISTRY & ORTHODONTICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven R. Lubbe, D.M.D.
Title
Vice President
Phone
(804) 739-0963

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

13463 Hull Street Rd.
Midlothian, VA 23112-2103

Mailing address

13463 Hull Street Rd.
Midlothian, VA 23112-2103
Phone (804) 739-0963

National Provider Directory

National Provider Directory
Tax ID family
Russell Mosher DDS PC6 organizations share this tax ID, including this one
Part of
Russell Mosher DDS PC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13463 Hull Street Rd
Midlothian, VA 23112
Phone (804) 739-0963

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1124579396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13463 HULL STREET RD.",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231122103",
            "telephone_number": "804-739-0963",
            "fax_number": "804-739-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13463 HULL STREET RD.",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231122103",
            "telephone_number": "804-739-0963",
            "fax_number": "804-739-0965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL VIRGINIA DENTAL CARE, P.L.C.-PEDIATRIC DENTISTRY & ORTHODONTIC",
        "enumeration_date": "2016-10-21",
        "last_updated": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "LUBBE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "804-739-0963",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.