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525 N Great Neck Rd Virginia Beach VA 23454-4035 | |
| (757) 340-8155 | |
| (757) 340-3919 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 525 N Great Neck Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Jennier Ross Waterman (DENTIST) |
| Authorized Official Contact | 7573408155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
525 N Great Neck Rd Virginia Beach VA 23454-4035 Ph: (757) 340-8155 | 525 N Great Neck Rd Virginia Beach VA 23454-4035 Ph: (757) 340-8155 |
| NPI Number | 1255762092 |
|---|---|
| Provider Enumeration Date | 12/04/2013 |
| Last Update Date | 12/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255762092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401411099 (Virginia) | Primary |
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