Organization
PEDIATRIC DENTAL SPECIALISTS OF HAMPTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANA D GRAHAM-MONTAQUE DDS (OWNER/PEDIATRIC DENTIST)
(804) 640-8545
Entity
Organization
Contact information
Practice address
2111 HARTFORD RD, HAMPTON, VA 23666-2576
(757) 903-4525
Mailing address
213 BULIFANTS BLVD STE B, WILLIAMSBURG, VA 23188-5733
(757) 903-4525
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401411505
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3061719
—
VA
Enumeration date
11/08/2016
Last updated
11/08/2016
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