Provider Demographics
NPI:1306342704
Name:PENINSULA FAMILY DENTISTRY
Entity type:Organization
Organization Name:PENINSULA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-874-8612
Mailing Address - Street 1:606 DENBIGH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4435
Mailing Address - Country:US
Mailing Address - Phone:757-874-8612
Mailing Address - Fax:757-243-8372
Practice Address - Street 1:606 DENBIGH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4435
Practice Address - Country:US
Practice Address - Phone:757-874-8612
Practice Address - Fax:757-243-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental