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Organization
DOMINION HEALTH MEDICAL ASSOCIATES
Active
Organization
DOMINION HEALTH MEDICAL ASSOCIATES
Active
Other names
Halifax Regional Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL HAZELWOOD (MANAGER DHG)
(434) 517-3515
Entity
Organization
Contact information
Practice address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-8361
(434) 517-8367
Mailing address
PO BOX 860, SOUTH BOSTON, VA 24592-0860
(434) 517-8361
(434) 517-8367
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401412161
VA
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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