| West End Pediatric Dentistry | |
|
12205 Gayton Road Suite A Richmond VA 23238-3212 | |
| (804) 741-1400 | |
| (804) 741-7700 |
| Full Name | West End Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12205 Gayton Road, Richmond, Virginia |
| Authorized Official Name and Position | David W Merrell (PEDIATRIC DENTIST) |
| Authorized Official Contact | 8047411400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West End Pediatric Dentistry 12205 Gayton Road Suite A Richmond VA 23238-3212 Ph: (804) 741-1400 | West End Pediatric Dentistry 12205 Gayton Road Suite A Richmond VA 23238-3212 Ph: (804) 741-1400 |
| NPI Number | 1144627555 |
|---|---|
| Provider Enumeration Date | 12/01/2014 |
| Last Update Date | 12/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144627555 | NPI | - | NPPES |
| 9178644 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 0401413933 (Virginia) | Primary |
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