Healthcare Provider Details

I. General information

NPI: 1750718177
Provider Name (Legal Business Name): VACENDAK DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 QUINCE PLACE
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

701 QUINCE PLACE
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-609-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHEILA VACENDAK
Title or Position: PRESIDENT
Credential:
Phone: 757-609-3510