Provider Demographics
NPI:1730566704
Name:ART OF DENTISTRY VB PC
Entity type:Organization
Organization Name:ART OF DENTISTRY VB PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-481-3699
Mailing Address - Street 1:2142 GREAT NECK SQ
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2202
Mailing Address - Country:US
Mailing Address - Phone:757-481-3699
Mailing Address - Fax:757-481-1494
Practice Address - Street 1:2142 GREAT NECK SQ
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2202
Practice Address - Country:US
Practice Address - Phone:757-481-3699
Practice Address - Fax:757-481-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401005455122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427361575OtherNON PARTICIPATING PROVIDER FOR MEDICARE
VA1669539490OtherNON PARTICIPATING PROVIDER FOR MEDICARE