| Va Smile Foundation, Inc. | |
|
12 Musket Ln Hampton VA 23666-5345 | |
| (757) 927-7477 | |
| (757) 654-3194 |
| Full Name | Va Smile Foundation, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12 Musket Ln, Hampton, Virginia |
| Authorized Official Name and Position | Kenyuatia Lynn Gash (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7579277477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Va Smile Foundation, Inc. 110 Coliseum Xing Ste 5142 Hampton VA 23666-5971 Ph: (757) 927-7477 | Va Smile Foundation, Inc. 12 Musket Ln Hampton VA 23666-5345 Ph: (757) 927-7477 |
| NPI Number | 1043051642 |
|---|---|
| Provider Enumeration Date | 06/05/2024 |
| Last Update Date | 06/05/2024 |
| Certification Date | 06/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043051642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
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