is a Pediatric Dentistry in Glen Allen, Virginia. practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for is 1922119882. The last update date is .
's current location address is 4912 Olde Mill Pond Lane, Glen Allen, Virginia. You can contact this provider via phone number 8049670432. The mailing address for is 4912 Olde Mill Pond Lane, Glen Allen, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 4912 Olde Mill Pond Lane, Glen Allen, Virginia |
| Phone Number | 8049670432 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1922119882 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 4912 Olde Mill Pond Lane |
|---|---|
| City | Glen Allen |
| State | Virginia (VA) |
| Post Code | 23060 |
| Phone Number | 8049670432 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | 401410866 |
|
Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 10866 | VA | DELTA DENTAL | |
| 143640 | VA | ANTHEM |
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