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Organization
NANSEMOND SUFFOLK ORAL CARE
Active
Organization
NANSEMOND SUFFOLK ORAL CARE
Active
Other names
Dr Wyatt M Ruffin Jr
Organization subpart
No
Provider details
NPI number
Authorized official
WYATT M RUFFIN JR. DDS (OWNER PRESIDENT)
(757) 465-4884
Entity
Organization
Contact information
Practice address
3940 AIRLINE BLVD, CHESAPEAKE, VA 23321-3329
(757) 465-4884
(757) 465-4884
Mailing address
3940 AIRLINE BLVD, SUITE 114, CHESAPEAKE, VA 23321-3329
(757) 465-4884
(757) 465-4884
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7821743
—
VA
Enumeration date
11/13/2006
Last updated
08/22/2020
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