# TREMONT ROAD DENTAL, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1780771378
- **Authorized official:** MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (770) 916-5036

## Contact information

- **Practice address:** 4239 HOLLAND ROAD, SUITE 762-A, VIRGINIA BEACH, VA 23452
- **Practice address phone:** (757) 467-5665
- **Practice address fax:** (757) 467-1455
- **Mailing address:** 210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
- **Mailing address phone:** (770) 916-9000
- **Mailing address fax:** (678) 247-7858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 05/27/2022