Organization
COLISEUM PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE O DAVIS (BUSINESS ADMINISTRATOR)
(757) 369-1754
Entity
Organization
Contact information
Practice address
2113 HARTFORD RD STE C, HAMPTON, VA 23666-2575
(757) 838-0800
(757) 827-8532
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
—
—
Other
Enumeration date
05/26/2010
Last updated
05/29/2019
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