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836 First Colonial Rd Virginia Beach VA 23451-6126 | |
| (757) 428-8747 | |
| (757) 422-8165 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 836 First Colonial Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Ty Justice (DIRECTOR, PAYER RELATIONS) |
| Authorized Official Contact | 5138084984 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9825 Kenwood Rd Ste 200 Blue Ash OH 45242-6252 Ph: (513) 609-4076 | 836 First Colonial Rd Virginia Beach VA 23451-6126 Ph: (757) 428-8747 |
| NPI Number | 1972149789 |
|---|---|
| Provider Enumeration Date | 11/27/2019 |
| Last Update Date | 03/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972149789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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