Island Dental | |
3897 Main St Chincoteague Island VA 23336-1809 | |
(757) 336-5116 | |
(757) 336-2227 |
Full Name | Island Dental |
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Speciality | Dentist - General Practice |
Location | 3897 Main St, Chincoteague Island, Virginia |
Authorized Official Name and Position | Ellen Kellam Spence (OFFICE MANAGER) |
Authorized Official Contact | 7573365116 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Island Dental 3897 Main St Chincoteague Island VA 23336-1809 Ph: (757) 336-5116 | Island Dental 3897 Main St Chincoteague Island VA 23336-1809 Ph: (757) 336-5116 |
NPI Number | 1013320688 |
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Provider Enumeration Date | 06/11/2014 |
Last Update Date | 06/11/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013320688 | NPI | - | NPPES |
1417977158 | Other | VA | NPI |
0401005191 | Other | VA | DENTAL LICENSE |
2136095645751 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 0401005191 (Virginia) | Primary |