| Organization Name: | COMMONWEALTH PEDIATRIC DENTAL SPECIALISTS |
| NPI Number: | 1679978795 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOY PHELPS (PEDIATRIC DENTIST/OWNER) |
| Mailing Address: | 5506 Whiteside Road Sandston |
| State: | VA US |
| Postal Code: | 231502345 |
| Phone Number: | 6178756808 |
| Fax Number: | |
| NPI Enumeration Date: | 10/31/2014 |
| NPI Last Update Date: | 10/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 401411512 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |