Organization
HAMPTON ROADS PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Active
Other names
Hampton Roads Pediatric Dentistry and Orthodontics, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE O DAVIS (BUSINESS ADMINISTRATOR)
(757) 369-1754
Entity
Organization
Contact information
Practice address
220 NAT TURNER BLVD S, NEWPORT NEWS, VA 23606-2998
(757) 240-5711
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
0401410912
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401414620
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401412905
VA
Other
Enumeration date
02/12/2015
Last updated
04/12/2019
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