Organization
JEREMY SHULMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROCHELLE DENISE CUBITT (OFFICE MANAGER)
(757) 496-8070
Entity
Organization
Contact information
Practice address
1301 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-2263
(757) 496-8070
Mailing address
2061 THOMAS BISHOP LN, VIRGINIA BEACH, VA 23454-1129
(757) 496-8070
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401002488
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147713
ANTHEM PROVIDER NUMBER
VA
01
—
177146
UNITED CONCORDIA DENTAL
VA
01
—
231794
CIGNA DENTAL
VA
01
—
C08502040
SUBMITTER ID
VA
Enumeration date
04/25/2008
Last updated
11/03/2011
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