Organization
CENTREVILLE PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS CANNON (RCM)
(757) 869-9916
Entity
Organization
Contact information
Practice address
14701 LEE HWY, STE 107-108, CENTREVILLE, VA 20121-2137
(757) 869-9916
(757) 898-4919
Mailing address
3120 KILN CREEK PKWY, STE P, NEWPORT NEWS, VA 23601-3651
(757) 869-9916
(757) 898-4919
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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