Organization
HAMPTON ROADS PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Active
Parent organization
HAMPTON ROADS PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Other names
Courthouse Pediatric Dentistry, Gloucester Pediatric Dentistry and Behl Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
HAMPTON ROADS PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Authorized official
GRACE O DAVIS (BUSINESS ADMINISTRATOR)
(757) 369-1754
Entity
Organization
Contact information
Practice address
6882 MAIN ST, GLOUCESTER, VA 23061-5163
(804) 695-2575
(804) 695-2815
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
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401412905
VA
Other
Enumeration date
11/10/2015
Last updated
04/12/2019
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