Organization
PEDIATRIC DENTAL CARE OF TIDEWATER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORGAN TREY WEIS (OWNER)
(757) 484-8262
Entity
Organization
Contact information
Practice address
5915 HIGH STREET WEST, PORTSMOUTH, VA 23703
(757) 484-8262
(757) 638-3632
Mailing address
5915 HIGH ST W, PORTSMOUTH, VA 23703-4505
(757) 484-8262
(757) 638-3632
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401410496
VA
Other
Enumeration date
04/27/2007
Last updated
01/03/2025
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