Organization
DOMINION HEALTH MEDICAL ASSOCIATES
Active
Other names
Halifax Regional Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL HAZELWOOD (MANAGER DHG)
(434) 517-3515
Entity
Organization
Contact information
Practice address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-8361
(434) 517-8367
Mailing address
PO BOX 860, SOUTH BOSTON, VA 24592-0860
(434) 517-8361
(434) 517-8367
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401412161
VA
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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