# CHESAPEAKE FAMILY DENTAL

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

## Provider details

- **NPI number:** 1629322615
- **Authorized official:** DR. OSAMA S MODJADIDI DMD (OWNER)
- **Authorized official phone:** (757) 548-5619

## Contact information

- **Practice address:** 113 GAINSBOROUGH SQ, SUITE 101, CHESAPEAKE, VA 23320-1713
- **Practice address phone:** (757) 548-5619
- **Practice address fax:** (757) 548-6930
- **Mailing address:** 113 GAINSBOROUGH SQ, SUITE 101, CHESAPEAKE, VA 23320-1713
- **Mailing address fax:** (757) 548-6930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 10/30/2012
- **Last updated:** 10/30/2012