Basic Information
| Provider Information | |||||||||
| NPI: | 1467903104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ATLEE FAMILY AND COSMETIC DENTISTRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10640 CHARTER HILL CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230057749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045501222 | ||||||||
| FaxNumber: | 8045500753 | ||||||||
| Practice Location | |||||||||
| Address1: | 10640 CHARTER HILL CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230057749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045501222 | ||||||||
| FaxNumber: | 8045500753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BIRD | ||||||||
| AuthorizedOfficialFirstName: | ELIOT | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8045501222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTRAL VIRGINIA DENTAL CARE | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401007232 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.