Healthcare Provider Details

I. General information

NPI: 1871583393
Provider Name (Legal Business Name): WILLIAMSBURG AREA MEDICAL ASSISTANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 OLDE TOWNE RD
WILLIAMSBURG VA
23188-8111
US

IV. Provider business mailing address

5249 OLDE TOWNE RD
WILLIAMSBURG VA
23188-8111
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-3254
  • Fax: 757-220-1953
Mailing address:
  • Phone: 757-259-3254
  • Fax: 757-220-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401002784
License Number StateVA

VIII. Authorized Official

Name: MRS. DENISE A. BOWLES
Title or Position: BUSINESS MANAGER
Credential:
Phone: 757-259-3254