NPIMap

Organization Active NPI

CD Virginia Dental, P.C.

  • General Practice Dentistry
  • Virginia Beach, VA
National Provider Identifier
1972149789
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CD VIRGINIA DENTAL, P.C.
Practice address
836 First Colonial Rd
Virginia Beach, VA 23451-6126
Phone
(757) 428-8747
Fax
(757) 422-8165
NPI assigned
Nov 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Ty Justice
Title
Director, Payer Relations
Phone
(513) 808-4984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

836 First Colonial Rd
Virginia Beach, VA 23451-6126

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 609-4076

Other names 1

  • General & Implant Dentistry of Tidewater Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CD Virginia Dental PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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": "1574812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1972149789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-609-4076",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 FIRST COLONIAL RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234516126",
            "telephone_number": "757-428-8747",
            "fax_number": "757-422-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD VIRGINIA DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-27",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "513-808-4984"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "General & Implant Dentistry of Tidewater",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

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