# TIDEWATER DENTAL CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275789950
- **Authorized official:** MS. AMY D FORD (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (757) 622-4245

## Contact information

- **Practice address:** 425 W 20TH ST, 3, NORFOLK, VA 23517-2128
- **Practice address phone:** (757) 622-4245
- **Practice address fax:** (757) 622-3722
- **Mailing address:** 425 W 20TH ST, 3, NORFOLK, VA 23517-2128
- **Mailing address phone:** (757) 622-4245
- **Mailing address fax:** (757) 622-3722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401411261 | VA | Yes |

## Other

- **Enumeration date:** 08/13/2008
- **Last updated:** 08/13/2008