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Organization

COSMETIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TAYLOR HICKMAN (OFFICE ASSISTANT)
(757) 366-0330
Entity
Organization

Contact information

Practice address
931 PROVIDENCE RD, CHESAPEAKE, VA 23325-4200
(757) 366-0330
(757) 366-0550
Mailing address
931 PROVIDENCE RD, CHESAPEAKE, VA 23325-4200
(757) 366-0330
(757) 366-0550

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
0401411210
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1649318247
NPI
VA
01
1992010953
THAMES NPI
VA
Enumeration date
11/01/2016
Last updated
11/01/2016
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