Organization
TIDEWATER DENTAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY D FORD (VICE PRESIDENT OF OPERATIONS)
(757) 622-4245
Entity
Organization
Contact information
Practice address
425 W 20TH ST, 3, NORFOLK, VA 23517-2128
(757) 622-4245
(757) 622-3722
Mailing address
425 W 20TH ST, 3, NORFOLK, VA 23517-2128
(757) 622-4245
(757) 622-3722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411261
VA
Other
Enumeration date
08/13/2008
Last updated
08/13/2008
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