# DOMINION HEALTH MEDICAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Halifax Regional Dental Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508110057
- **Authorized official:** CECIL HAZELWOOD (MANAGER DHG)
- **Authorized official phone:** (434) 517-3515

## Contact information

- **Practice address:** 101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
- **Practice address phone:** (434) 517-8361
- **Practice address fax:** (434) 517-8367
- **Mailing address:** PO BOX 860, SOUTH BOSTON, VA 24592-0860
- **Mailing address phone:** (434) 517-8361
- **Mailing address fax:** (434) 517-8367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401412161 | VA | Yes |

## Other

- **Enumeration date:** 11/06/2012
- **Last updated:** 11/06/2012