Active NPI
Daniel M Etheridge, DDS
- Dentist
- Chesapeake, VA
National Provider Identifier
1326174343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401006341
- Practice address
- 1059 Eden Way N Ste 100
Chesapeake, VA 23320-2789 - Phone
- (757) 547-2266
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401006341 | VA | Primary |
Addresses
Primary practice location
1059 Eden Way N Ste 100
Chesapeake, VA 23320-2789
Mailing address
1059 Eden Way N Ste 100
Chesapeake, VA 23320-2789
Phone (757) 547-2266
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 504368 | Other | UNITED CONCORDIA | |
| 010397 | Other | VA | ANTHEM BC & BS OF VA |
| 6341 | Other | VA | DELTA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 8, 2013 through Nov 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Daniel M Etheridge DDS LTD | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326174343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1059 EDEN WAY N STE 100",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233202789",
"telephone_number": "757-547-2266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1059 EDEN WAY N STE 100",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233202789",
"telephone_number": "757-547-2266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHERIDGE",
"first_name": "DANIEL",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401006341",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "504368",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC & BS OF VA",
"identifier": "010397",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA",
"identifier": "6341",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.