| |
3720 Holland Rd Ste 102 Virginia Beach VA 23452-2859 | |
(240) 501-6745 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 3720 Holland Rd, Virginia Beach, Virginia |
Authorized Official Name and Position | David R Throckmorton (OWNER) |
Authorized Official Contact | 7574981663 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3720 Holland Rd Ste 102 Virginia Beach VA 23452-2859 Ph: () - | 3720 Holland Rd Ste 102 Virginia Beach VA 23452-2859 Ph: (240) 501-6745 |
NPI Number | 1780953125 |
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Provider Enumeration Date | 12/14/2011 |
Last Update Date | 07/31/2023 |
Medicare PECOS PAC ID | 0547506529 |
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Medicare Enrollment ID | O20190111001754 |
Identifier | Type | State | Issuer |
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1780953125 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 0401411064 (Virginia) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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