Pediatric Dental Specialists of Hampton

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

0401411505 Issued in VA

Legal business name

PEDIATRIC DENTAL SPECIALISTS OF HAMPTON

Practice address

2111 Hartford Rd
Hampton, VA 23666-2576

Phone

(757) 903-4525

NPI assigned

Nov 8, 2016

Last updated

Nov 8, 2016By 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

Dr. Rana D Graham-Montaque, DDS

Title

Owner/Pediatric Dentist

Phone

(804) 640-8545

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Manuel Rodriguez-Lichtenberg, DDS, MPH

  • Pediatric Dentistry
  • Midlothian, VA
  • NPI 1790318152
  NPD (past)

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1720520794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 BULIFANTS BLVD STE B",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885733",
            "telephone_number": "757-903-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 HARTFORD RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662576",
            "telephone_number": "757-903-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SPECIALISTS OF HAMPTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "GRAHAM-MONTAQUE",
        "authorized_official_first_name": "RANA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "804-640-8545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401411505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3061719",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tisha Marie Payne
• Peace of Mind Mental Health Services LLC (DBA Lifeologie Counseling Hampton Roads)
• Peaceful Minds Services LLC
• Peartree Health Care
• Pediatric Center PC
• Pediatrics at the Hamptons (Dr. Angela Odom Austin)
• Stephanie L Peglow, DO
• Jiten Ralph Peiris
• Peninsula Behavioral Consulting
• Peninsula Child & Family Services LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; 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.