NPIMap

Organization Active NPI

Tennessee Enhanced Dental Services LLC

  • Dentist
  • Virginia Beach, VA
National Provider Identifier
1215015250
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401006498 Issued in VA
Legal business name
TENNESSEE ENHANCED DENTAL SERVICES LLC
Practice address
1301 First Colonial Blvd
Virginia Beach, VA 23454
Phone
(757) 463-1500
Fax
(757) 463-8727
NPI assigned
Nov 1, 2006
Last updated
Jul 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Dr. Jeffrey Randall Leidy, DMDNPI 1891934592
Title
President Owner
Phone
(757) 463-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401006498 VA Primary

Addresses

Primary practice location

1301 First Colonial Blvd
Virginia Beach, VA 23454

Mailing address

1301 First Colonial Blvd (Headquarters)
Virginia Beach, VA 23454
Phone (757) 463-1500

Other names 1

  • Jeffrey R Leidy DMD LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

1301 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 463-1500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1215015250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 FIRST COLONIAL BLVD (HEADQUARTERS)",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23454",
            "telephone_number": "757-463-1500",
            "fax_number": "757-463-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 FIRST COLONIAL BLVD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23454",
            "telephone_number": "757-463-1500",
            "fax_number": "757-463-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE ENHANCED DENTAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "LEIDY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "757-463-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401006498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffrey R Leidy DMD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.