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General NPI Number Information
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NPI Number | 1043717457
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE FAMILY AND IMPLANT DENTISTRY LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | CHESAPEAKE FAMILY AND IMPLANT DENTISTRY 516 INNOVATION DR. SUITE 302
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-436-0026
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Fax | 757-547-5658
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Provider Business Mailing Address
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Address Line | CHESAPEAKE FAMILY AND IMPLANT DENTISTRY LLC 516 INNOVATION DR. SUITE 302
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-436-0026
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Fax | 757-547-5658
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. PATTY LYNN HEBERLING
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Credential |
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Telephone | 757-436-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0401006063
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401006063
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License Number State | VA
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