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2100 Lynnhaven Pkwy Suite 100 Virginia Beach VA 23456-1492 | |
| (757) 416-1800 | |
| (757) 416-9276 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2100 Lynnhaven Pkwy, Virginia Beach, Virginia |
| Authorized Official Name and Position | Mike Cole (VP INSURANCE PLAN MANAGEMENT) |
| Authorized Official Contact | 7274242990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2100 Lynnhaven Pkwy Suite 100 Virginia Beach VA 23456-1492 Ph: (757) 416-1800 | 2100 Lynnhaven Pkwy Suite 100 Virginia Beach VA 23456-1492 Ph: (757) 416-1800 |
| NPI Number | 1063570968 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063570968 | NPI | - | NPPES |
| 019711 | Other | VA | ANTHEM |
| 816276 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Virginia) | Primary |
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