Coliseum Pediatric Dentistry Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

COLISEUM PEDIATRIC DENTISTRY SURGERY CENTER

Doing business as

Coliseum Pediatric Dentistry Surgery Center

Practice address

2113 Hartford Rd
Hampton, VA 23666-2575

Phone

(757) 327-7843

NPI assigned

Apr 22, 2024

Last updated

Apr 22, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

COLISEUM PEDIATRIC DENTISTRY PLLCAs reported in NPPES

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

Authorized official

Name

Chris Cannon

Title

RCM

Phone

(757) 327-4843

Specialties & licenses 2

Addresses

Other names 1

• Coliseum Pediatric Dentistry Surgery Center Doing business as

Tax ID family

Coliseum Pediatric Dentistry PLLC2 organizations share this tax ID, including this one

Part of

Coliseum Pediatric Dentistry PLLC

Other organizations with this tax ID 1

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

• Coliseum Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Hampton, VA
  • NPI 1467771766
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Coliseum Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Hampton, VA
  • NPI 1467771766
  NPPES parent name

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

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1700631801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 HARTFORD RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662575",
            "telephone_number": "757-838-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 HARTFORD RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662575",
            "telephone_number": "757-327-7843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2111 Hartford Rd",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236662576",
            "country_code": "US",
            "telephone_number": "757-327-7843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLISEUM PEDIATRIC DENTISTRY SURGERY CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLISEUM PEDIATRIC DENTISTRY PLLC",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "RCM",
        "authorized_official_telephone_number": "757-327-4843"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coliseum Pediatric Dentistry Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew Bruce Cole, M.D.
• Adam Jerel Coleman, M.S.W.
• Robyn Grannette Coleman, LCSW
• Kenneth Donnell Coles
• Coliseum Pediatric Dentistry PLLC
• Collaborative Health
• Lajuana M Collins, MD
• Marisa Collins, M.A. CCC-SLP
• Jason Todd Combs, MD
• Comfort Haven Community LLC

• Ambulatory Surgical Clinic/Center in Hampton, VA
• Providers in Hampton, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.