NPIMap

Organization Active NPI

JDM Dental, PLC

  • Dentist
  • Chester, VA
National Provider Identifier
1154605384
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401411812 Issued in VA
Legal business name
JDM DENTAL, PLC
Practice address
4516 W Hundred Rd
Chester, VA 23831-1740
Phone
(804) 909-5709
Fax
(804) 748-8053
NPI assigned
Oct 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Authorized official

Name
Dr. Jeffrey D MaurerNPI 1720282874
Title
Dentist
Phone
(804) 748-8677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0401411812 VA Primary

Addresses

Primary practice location

4516 W Hundred Rd
Chester, VA 23831-1740

Mailing address

4516 W Hundred Rd
Chester, VA 23831-1740
Phone (804) 909-5709

National Provider Directory

National Provider Directory

Locations

4516 W Hundred Rd
Chester, VA 23831
Phone (804) 748-8677

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1154605384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 W HUNDRED RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311740",
            "telephone_number": "804-909-5709",
            "fax_number": "804-748-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 W HUNDRED RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311740",
            "telephone_number": "804-909-5709",
            "fax_number": "804-748-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDM DENTAL, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "MAURER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "804-748-8677",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401411812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; 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.