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1909 Landstown Centre Way Suite 100 Virginia Beach VA 23456-1625 | |
| (757) 301-4119 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1909 Landstown Centre Way, Virginia Beach, Virginia |
| Authorized Official Name and Position | Carmen Woods (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175405141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1909 Landstown Centre Way Suite 100 Virginia Beach VA 23456-1625 Ph: (757) 301-4119 | 1909 Landstown Centre Way Suite 100 Virginia Beach VA 23456-1625 Ph: (757) 301-4119 |
| NPI Number | 1871981993 |
|---|---|
| Provider Enumeration Date | 12/23/2014 |
| Last Update Date | 12/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871981993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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