NPIMap

Organization Active NPI

Dominion Health Medical Associates

Doing business as Halifax Regional Dental Clinic

  • Dentist
  • South Boston, VA
National Provider Identifier
1508110057
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401412161 Issued in VA
Legal business name
DOMINION HEALTH MEDICAL ASSOCIATES
Doing business as
Halifax Regional Dental Clinic
Practice address
101 Aubreys Loop
South Boston, VA 24592-5056
Phone
(434) 517-8361
Fax
(434) 517-8367
NPI assigned
Nov 6, 2012
Last updated
Nov 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Authorized official

Name
Cecil Hazelwood
Title
Manager DHG
Phone
(434) 517-3515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401412161 VA Primary

Addresses

Primary practice location

101 Aubreys Loop
South Boston, VA 24592-5056

Mailing address

PO Box 860
South Boston, VA 24592-0860
Phone (434) 517-8361

Other names 1

  • Halifax Regional Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clarksville Family Practice7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1508110057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245920860",
            "telephone_number": "434-517-8361",
            "fax_number": "434-517-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 AUBREYS LOOP",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245925056",
            "telephone_number": "434-517-8361",
            "fax_number": "434-517-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "CECIL",
        "authorized_official_title_or_position": "MANAGER  DHG",
        "authorized_official_telephone_number": "434-517-3515"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Halifax Regional Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.