Provider Demographics
NPI:1699794263
Name:ATKINS, CARL ODEN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ODEN
Last Name:ATKINS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA04010061421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008222428Medicaid