MEDICARE: GOOD NEIGHBOR DENTAL AT EDINBURGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401007257	VA

General Provider Information

NPI Number	:	1528457488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NEIGHBOR DENTAL AT EDINBURGH

Provider Business Mailing Address
First Line	:	236 CARMICHAEL WAY
Second Line	:	SUITE 312
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-2185
Country	:	US
Telephone Number	:	757-932-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 CARMICHAEL WAY
Second Line	:	SUITE 312
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-2185
Country	:	US
Telephone Number	:	757-932-5200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. SHERYL ANNE BROWN
Credential	:
Telephone Number	:	757-784-8070

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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