Organization
PEDIATRIC DENTAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANA DENISE GRAHAM-MONTAQE DDS (OWNER/PEDIATRIC DENTIST)
(866) 977-4787
Entity
Organization
Contact information
Practice address
213 BULIFANTS BLVD STE B, WILLIAMSBURG, VA 23188-5733
(866) 977-4787
Mailing address
213 BULIFANTS BLVD STE B, WILLIAMSBURG, VA 23188-5733
(866) 977-4787
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401411505
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11505
—
VA
Enumeration date
09/16/2012
Last updated
09/16/2012
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