NPI 1134671514

Cosmetic Dentistry

Organisation Preferred Provider Organization Chesapeake, VA

Practice location

Address: 931 Providence Rd, Chesapeake, VA 23325-4200
Phone: (757) 366-0330
Fax: (757) 366-0550

Authorised official

Name: Taylor Hickman
Title: Office Assistant
Phone: (757) 366-0330

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 0401411210 (VA)

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Registry record

NPI: 1134671514
Entity type: Organization
NPI issued: 1 Nov 2016
Record last updated: 1 Nov 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.