Upper Mattaponi Indian Tribe
Organization Active NPI Dental Clinic/Center · Aylett, VA
NPI 1245098391 · NPPES record last updated Jun 27, 2024
Key facts
- NPI
- 1245098391
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- UPPER MATTAPONI INDIAN TRIBE
- Practice address
- 8014 Richmond Tappahannock Hwy
Aylett, VA 23009-3056 - Phone
- (804) 769-2015
- NPI assigned
- Mar 12, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- UPPER MATTAPONI INDIAN TRIBE
Authorized official
- Name
- Steven Tupponce
- Title
- Director-Umit Health Services
- Phone
- (804) 347-4109
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 4
Practitioners 10
-
Raven Custalow, AGPCNP-BC
-
Christina Barrett Hawkins, MD, MPH
-
Jessica Marie Jemison, NP, RN, LVT
-
Joynita R. Nicholson, D.O.
-
Caitlin Mackenzie O'Conner, DNP, FNP-C
-
Irene Molyneux Temple, LCSW
-
Alan K Tupponce, M.D.
-
Lori Ha, DDS
-
Kristine Shafer, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210923002671 | TX | Part B Supplier - Clinic/Group Practice | 4880091446 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Aylett, VA |
National Provider Directory
- Tax ID family
- Upper Mattaponi Indian Tribe
- Part of
- Upper Mattaponi Indian Tribe
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Pediatric Dentistry |
1223P0221X | |||
| Dental Clinic/Center | 261QD0000X | Yes |
Addresses
Primary practice location
8014 Richmond Tappahannock Hwy
Aylett, VA 23009-3056
Mailing address
13476 King William Rd
King William, VA 23086-3401
Phone (804) 769-0041
Other names
- Aylett Family Dentistry
Other providers in Aylett, VA
- Irene Molyneux Temple
- Lance Edward Townsend
- Trusted Care Private Duty Services
- Alan K Tupponce
- Upper Mattaponi Indian Tribe
- Upper Mattaponi Indian Tribe
- Melissa Valyo-Smith
- Kathryn Weakley
- Britten White
All providers in Aylett, VA · Dental Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.