Healthcare Provider Details

I. General information

NPI: 1457071508
Provider Name (Legal Business Name): MORRISON DENETAL GROUP WILLIAMSBURG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3329
US

IV. Provider business mailing address

7151 RICHMOND RD STE 305
WILLIAMSBURG VA
23188-7234
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-0330
  • Fax: 757-220-9067
Mailing address:
  • Phone: 757-258-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS CELESTE VAUGHN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 757-303-6172