Provider Demographics
NPI:1194108332
Name:OPTIMUM DENTAL
Entity type:Organization
Organization Name:OPTIMUM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-765-0055
Mailing Address - Street 1:7389 LEE HWY
Mailing Address - Street 2:STE. #101
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1736
Mailing Address - Country:US
Mailing Address - Phone:703-468-4437
Mailing Address - Fax:
Practice Address - Street 1:7389 LEE HWY
Practice Address - Street 2:STE. #101
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1736
Practice Address - Country:US
Practice Address - Phone:703-468-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental