Provider Demographics
NPI:1306520010
Name:THOMAS JEFFERSON DENTAL CARE, PLLC
Entity type:Organization
Organization Name:THOMAS JEFFERSON DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:MEIRELES
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-465-2136
Mailing Address - Street 1:3048 BERKMAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3404
Mailing Address - Country:US
Mailing Address - Phone:434-465-2136
Mailing Address - Fax:434-465-2136
Practice Address - Street 1:3048 BERKMAR DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-3404
Practice Address - Country:US
Practice Address - Phone:434-465-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty