Ladysmith Dental Center

Primary specialty

DentistTaxonomy code 122300000X

License

0401412257 Issued in VA

Legal business name

LADYSMITH DENTAL CENTER

Practice address

18010 Jefferson Davis Hwy
Ruther Glen, VA 22546-2922

Phone

(804) 589-1491

Fax

(804) 589-1494

NPI assigned

Jun 21, 2013

Last updated

Jun 21, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

LADYSMITH DENTAL CENTERAs reported in NPPES

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

Authorized official

Name

Kelly Lynn Rothenberger

Title

Office Manager

Phone

(804) 589-1491

Specialties & licenses 1

Addresses

Part of

Ladysmith Dental Center

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.

• Mohamed Ibrahim

  • Dentist
  • Ruther Glen, VA
  • NPI 1659888717
  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1912346073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18010 JEFFERSON DAVIS HWY",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225462922",
            "telephone_number": "804-589-1491",
            "fax_number": "804-589-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18010 JEFFERSON DAVIS HWY",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225462922",
            "telephone_number": "804-589-1491",
            "fax_number": "804-589-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LADYSMITH DENTAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LADYSMITH DENTAL CENTER",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "ROTHENBERGER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "804-589-1491"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Shanay Juggins, CNA AND RMA AND BSHA
• Andrea Helene Justice, LMT, CMT
• Kindred Spirits Home Health Care LLC (Kindred Spirits Home Health LLC)
• Kristen Marie King, CSAC-A
• Octavia L King
• Ladysmith Urgent Care Center
• Life Way Services
• Louis J. Korpics Jr., DDS, PC
• Nancy Christine Love I, LCSW
• Heather F Malloy

• Dentist in Ruther Glen, VA
• Providers in Ruther Glen, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.