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70 W Mercury Blvd Ste 102 Hampton VA 23669-2570 | |
| (757) 755-2929 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 70 W Mercury Blvd Ste 102, Hampton, Virginia |
| Authorized Official Name and Position | Carmen Woods (CREDENTIALING MANAGER) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
70 W Mercury Blvd Ste 102 Hampton VA 23669-2570 Ph: (757) 755-2929 | 70 W Mercury Blvd Ste 102 Hampton VA 23669-2570 Ph: (757) 755-2929 |
| NPI Number | 1649524752 |
|---|---|
| Provider Enumeration Date | 10/29/2012 |
| Last Update Date | 01/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649524752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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