Organization
RED MILL PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE O DAVIS (BUSINESS ADMINISTRATOR)
(757) 369-1754
Entity
Organization
Contact information
Practice address
2336 ELSON GREEN AVE STE 101, VIRGINIA BEACH, VA 23456-6939
(757) 301-2064
Mailing address
3120 KILN CREEK PKWY STE P, YORKTOWN, VA 23693-5648
(757) 369-1754
(757) 234-8891
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
VA
Other
Enumeration date
10/04/2016
Last updated
10/10/2024
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