NPIMap

Organization Active NPI

Petersburg Complete Dental Care PLLC

  • General Practice Dentistry
  • Petersburg, VA
National Provider Identifier
1770824435
Registry record updated May 7, 2013
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401412498 Issued in VA
Legal business name
PETERSBURG COMPLETE DENTAL CARE PLLC
Practice address
23 Goodrich Ave
Petersburg, VA 23805-2119
Phone
(804) 861-5237
NPI assigned
Mar 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2013

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

Authorized official

Name
Dr. Susan E St. George, D.D.S.NPI 1720393168
Title
Owner
Phone
(804) 861-5237

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 0401412498 VA Primary

Addresses

Primary practice location

23 Goodrich Ave
Petersburg, VA 23805-2119

Mailing address

23 Goodrich Ave
Petersburg, VA 23805-2119
Phone (804) 861-5237

National Provider Directory

National Provider Directory

Locations

23 Goodrich Ave
Petersburg, VA 23805
Phone (804) 861-5237

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1770824435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-861-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-861-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG COMPLETE DENTAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "ST. GEORGE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-861-5237",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401412498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.