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General NPI Number Information
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NPI Number | 1093591604
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Entity Type | Organization
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Legal Business Name | CUSP UNTETHERED, PLLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 4440 SHORE DR STE 100B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-3046
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Country | US
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Telephone | 757-904-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 4440 SHORE DR STE 100B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-3046
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Country | US
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Telephone | 757-904-4347
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ZANETA HAMLIN
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Credential |
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Telephone | 757-904-4347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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