Provider Demographics
NPI:1386736247
Name:ATKINS, MAESTRELLO & ASSOCIATES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:ATKINS, MAESTRELLO & ASSOCIATES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:GAINES
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-741-2226
Mailing Address - Street 1:2560 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1468
Mailing Address - Country:US
Mailing Address - Phone:804-741-2226
Mailing Address - Fax:804-741-6751
Practice Address - Street 1:2560 GASKINS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1468
Practice Address - Country:US
Practice Address - Phone:804-741-2226
Practice Address - Fax:804-741-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU49916Medicare UPIN