Pediatric Dental Care of Virginia

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0401410219 Issued in VA

Legal business name

PEDIATRIC DENTAL CARE OF VIRGINIA

Practice address

5126 King's Mountain Road
Collinsville, VA 24078

Phone

(276) 647-2033

Fax

(276) 647-2034

NPI assigned

May 4, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gabriel Malchijah Brown, DDS

Title

President

Phone

(540) 293-2289

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366654808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5126 KING'S MOUNTAIN ROAD",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "24078",
            "telephone_number": "276-647-2033",
            "fax_number": "276-647-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5126 KING'S MOUNTAIN ROAD",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "24078",
            "telephone_number": "276-647-2033",
            "fax_number": "276-647-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CARE OF VIRGINIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "MALCHIJAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-293-2289",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401410219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Collinsville, VA
• Providers in Collinsville, VA by specialty
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.