Healthcare Provider Details

I. General information

NPI: 1144291121
Provider Name (Legal Business Name): US NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 SHORELINE RD
CARROLLTON VA
23314-3368
US

IV. Provider business mailing address

USS CARL VINSON,CVN70 DENTAL DEPT
FPO AE
09566
US

V. Phone/Fax

Practice location:
  • Phone: 917-224-4968
  • Fax:
Mailing address:
  • Phone: 757-534-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050886
License Number StateNY

VIII. Authorized Official

Name: DR. MELISSA PAIGE FRIES
Title or Position: DENTIST
Credential: D.D.S.
Phone: 917-224-4968