Individual
DR. PETER DALE VANSICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
4208 SEASIDE RD, EXMORE, VA 23350-2575
(757) 442-5005
(757) 442-5005
Mailing address
4208 SEASIDE RD, EXMORE, VA 23350-2575
(757) 442-5005
(757) 442-5005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401005066
VA
Other
Enumeration date
08/17/2006
Last updated
09/21/2009
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