# TIDEWATER DENTAL STUDIO PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tidewater Dental Studio
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295621076
- **Authorized official:** DR. JOANNA MARIE S. ACOSTA-SASSOON DDS (OWNER)
- **Authorized official phone:** (757) 499-8139

## Contact information

- **Practice address:** 4867 BAXTER RD STE 101, VIRGINIA BEACH, VA 23462-4469
- **Practice address phone:** (757) 499-8139
- **Practice address fax:** (757) 473-8816
- **Mailing address:** 4867 BAXTER RD STE 101, VIRGINIA BEACH, VA 23462-4469
- **Mailing address phone:** (757) 499-8139
- **Mailing address fax:** (757) 473-8816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/17/2025
- **Last updated:** 06/17/2025