NPIMap

Organization Active NPI

Pediatric Dental Care of Tidewater PC

  • Pediatric Dentistry
  • Portsmouth, VA
National Provider Identifier
1891915112
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401410496 Issued in VA
Legal business name
PEDIATRIC DENTAL CARE OF TIDEWATER PC
Practice address
5915 High Street West
Portsmouth, VA 23703
Phone
(757) 484-8262
Fax
(757) 638-3632
NPI assigned
Apr 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Morgan Trey WeisNPI 1033192398
Title
Owner
Phone
(757) 484-8262

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 0401410496 VA Primary

Addresses

Primary practice location

5915 High Street West
Portsmouth, VA 23703

Mailing address

5915 High St W
Portsmouth, VA 23703-4505
Phone (757) 484-8262

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dental Care of Tidewater PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

5915 High St W
Portsmouth, VA 23703
Phone (757) 484-8262

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1891915112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 HIGH ST W",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237034505",
            "telephone_number": "757-484-8262",
            "fax_number": "757-638-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 HIGH STREET WEST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "23703",
            "telephone_number": "757-484-8262",
            "fax_number": "757-638-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CARE OF TIDEWATER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "WEIS",
        "authorized_official_first_name": "MORGAN",
        "authorized_official_middle_name": "TREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-484-8262"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401410496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.