Provider Demographics
NPI:1063955250
Name:COMMONWEALTH PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:COMMONWEALTH PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-808-1657
Mailing Address - Street 1:201 A ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1613
Mailing Address - Country:US
Mailing Address - Phone:434-808-1657
Mailing Address - Fax:434-710-4030
Practice Address - Street 1:201 A ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1613
Practice Address - Country:US
Practice Address - Phone:434-808-1657
Practice Address - Fax:434-710-4030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty