| Na | |
|
909 Glenrock Rd Suite -c Norfolk VA 23502-3796 | |
| (757) 461-8760 | |
| Not Available |
| Full Name | Na |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 909 Glenrock Rd, Norfolk, Virginia |
| Authorized Official Name and Position | Norman Patrick Moore (PRESIDENT) |
| Authorized Official Contact | 7574618760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 909 Glenrock Road Suite -c Norfolk VA 23502 Ph: (757) 461-8760 | Na 909 Glenrock Rd Suite -c Norfolk VA 23502-3796 Ph: (757) 461-8760 |
| NPI Number | 1174546550 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174546550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2573 (Virginia) | Primary |
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