Healthcare Provider Details

I. General information

NPI: 1053708461
Provider Name (Legal Business Name): ANTHONY WALTER SAVAGE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 FIRST COLONIAL ROAD
VIRGINA BEACH VA
23451-6177
US

IV. Provider business mailing address

829 FIRST COLONIAL ROAD
VIRGINA BEACH VA
23451-6177
US

V. Phone/Fax

Practice location:
  • Phone: 757-428-1110
  • Fax: 757-282-2448
Mailing address:
  • Phone: 757-428-1110
  • Fax: 757-282-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number401006285
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: