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Organization
CD VIRGINIA DENTAL P.C.
Active
Organization
CD VIRGINIA DENTAL P.C.
Active
Other names
Providence Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
TY JUSTICE (DIRECTOR, PAYER RELATIONS)
(513) 808-4984
Entity
Organization
Contact information
Practice address
931 PROVIDENCE RD, CHESAPEAKE, VA 23325-4200
(757) 366-0330
(757) 366-0550
Mailing address
9825 KENWOOD RD STE 200, BLUE ASH, OH 45242-6252
(513) 609-4076
(513) 448-0511
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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