Organization Active NPI

Southside Family and Cosmetic Dentistry

  • General Practice Dentistry
  • Colonial Heights, VA
National Provider Identifier
1295008985
Registry record updated Feb 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401411798 Issued in VA
Legal business name
SOUTHSIDE FAMILY AND COSMETIC DENTISTRY
Practice address
3505 Boulevard
Colonial Heights, VA 23834-1319
Phone
(804) 520-5009
Fax
(804) 520-0901
NPI assigned
Feb 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2012

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

Authorized official

Name
Dr. Tonya Adrena Parris-Wilkins, D.D.S.
Title
President
Phone
(804) 520-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 0401411798 VA Primary

Addresses

Primary practice location

3505 Boulevard
Colonial Heights, VA 23834-1319

Mailing address

3505 Boulevard
Colonial Heights, VA 23834-1319
Phone (804) 520-5009

National Provider Directory

National Provider Directory

Locations

3505 Boulevard
Colonial Heights, VA 23834
Phone (804) 520-5009

Practitioners & affiliated clinicians

Practitioners 1

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": "1329004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329004800000",
    "number": "1295008985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 BOULEVARD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341319",
            "telephone_number": "804-520-5009",
            "fax_number": "804-520-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 BOULEVARD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341319",
            "telephone_number": "804-520-5009",
            "fax_number": "804-520-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY AND COSMETIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-12",
        "last_updated": "2012-02-12",
        "status": "A",
        "authorized_official_last_name": "PARRIS-WILKINS",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "ADRENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-520-5009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colonial Heights, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2012; 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.