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Organization
UPPER MATTAPONI INDIAN TRIBE
Active
Organization
UPPER MATTAPONI INDIAN TRIBE
Active
Parent organization
UPPER MATTAPONI INDIAN TRIBE
Other names
Aylett Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
UPPER MATTAPONI INDIAN TRIBE
Authorized official
STEVEN TUPPONCE (DIRECTOR-UMIT HEALTH SERVICES)
(804) 347-4109
Entity
Organization
Contact information
Practice address
8014 RICHMOND TAPPAHANNOCK HWY, AYLETT, VA 23009-3056
(804) 769-2015
Mailing address
13476 KING WILLIAM RD, KING WILLIAM, VA 23086-3401
(804) 769-0041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/12/2024
Last updated
06/27/2024
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