# COURTHOUSE PEDIATRIC DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gloucester PD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790573731
- **Authorized official:** CHRIS L CANNON (RCM)
- **Authorized official phone:** (804) 695-2575

## Contact information

- **Practice address:** 6750 MAIN ST, GLOUCESTER, VA 23061-5517
- **Practice address phone:** (804) 695-2575
- **Practice address fax:** (804) 695-2815
- **Mailing address:** 6750 MAIN ST, GLOUCESTER, VA 23061-5517
- **Mailing address phone:** (804) 695-2575
- **Mailing address fax:** (804) 695-2815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2025
- **Last updated:** 04/29/2025