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814 Newtown Rd Virginia Beach VA 23462-1116 | |
| (757) 490-0419 | |
| (757) 490-0870 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 814 Newtown Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Bruce Harold Utterback (PRESIDENT) |
| Authorized Official Contact | 7574900419 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
814 Newtown Rd Virginia Beach VA 23462-1116 Ph: (757) 490-0419 | 814 Newtown Rd Virginia Beach VA 23462-1116 Ph: (757) 490-0419 |
| NPI Number | 1548376361 |
|---|---|
| Provider Enumeration Date | 08/22/2006 |
| Last Update Date | 07/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548376361 | NPI | - | NPPES |
| 389874 | Other | VA | ANTHEM |
| 578059 | Other | VA | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | VA401007145 (Virginia) | Primary |
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