Organization
KV ORTHODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (CREDENTIALING SUPERVISOR)
(305) 274-2499
Entity
Organization
Contact information
Practice address
5241 PROVIDENCE RD, VIRGINIA BEACH, VA 23464-4201
(757) 495-3110
Mailing address
5241 PROVIDENCE RD, VIRGINIA BEACH, VA 23464-4201
(757) 495-3110
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
10/18/2018
Last updated
10/18/2021
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