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1300 Kempsville Rd Ste 5 Virginia Beach VA 23464-6199 | |
| (757) 467-7797 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1300 Kempsville Rd Ste 5, Virginia Beach, Virginia |
| Authorized Official Name and Position | Jessica Michelle Clark (PEDIATRIC DENTIST) |
| Authorized Official Contact | 7574677797 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1300 Kempsville Rd Ste 5 Virginia Beach VA 23464-6199 Ph: (757) 467-7797 | 1300 Kempsville Rd Ste 5 Virginia Beach VA 23464-6199 Ph: (757) 467-7797 |
| NPI Number | 1235642828 |
|---|---|
| Provider Enumeration Date | 11/06/2017 |
| Last Update Date | 11/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235642828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 04041414334 (Virginia) | Primary |
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