Individual
KIM T VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1907 HUGUENOT RD, NORTH CHESTERFIELD, VA 23235
(804) 379-6806
Mailing address
1907 HUGUENOT RD, NORTH CHESTERFIELD, VA 23235-4325
(804) 379-6806
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401416121
VA
Other
Enumeration date
07/13/2018
Last updated
07/24/2018
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