Provider Demographics
NPI:1861576332
Name:CHARLOTTESVILLE AREA DENTAL ACCESS INC
Entity type:Organization
Organization Name:CHARLOTTESVILLE AREA DENTAL ACCESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEYBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-293-9300
Mailing Address - Street 1:2778 HYDRAULIC ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8947
Mailing Address - Country:US
Mailing Address - Phone:434-293-9300
Mailing Address - Fax:434-973-9310
Practice Address - Street 1:2778 HYDRAULIC ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8947
Practice Address - Country:US
Practice Address - Phone:434-293-9300
Practice Address - Fax:434-973-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9179132Medicaid