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General NPI Number Information
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NPI Number | 1023568995
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Entity Type | Organization
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Legal Business Name | RED MILL PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 2336 ELSON GREEN AVE STE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6939
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Country | US
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Telephone | 757-301-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 KILN CREEK PKWY STE P
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City | YORKTOWN
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State | VA
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Zip | 23693-5648
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Country | US
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Telephone | 757-369-1754
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Fax | 757-234-8891
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | GRACE O DAVIS
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Credential |
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Telephone | 757-369-1754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | VA
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