Provider Demographics
NPI:1205045648
Name:VIRGINIA ORTHODONTIC SEPCIALIST
Entity type:Organization
Organization Name:VIRGINIA ORTHODONTIC SEPCIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:757-340-9020
Mailing Address - Street 1:829 LYNNHAVEN PKWY STE 121
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7224
Mailing Address - Country:US
Mailing Address - Phone:757-340-9020
Mailing Address - Fax:
Practice Address - Street 1:829 LYNNHAVEN PKWY STE 121
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7224
Practice Address - Country:US
Practice Address - Phone:757-340-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty