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General NPI Number Information
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NPI Number | 1124572417
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Entity Type | Organization
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Legal Business Name | ISLE OF WIGHT FAMILY & COSMETIC DENTISTRY PC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 4053 TAYLOR RD SUITE J
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5537
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Country | US
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Telephone | 757-484-2382
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Fax | 757-484-2383
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Provider Business Mailing Address
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Address Line | 4053 TAYLOR RD SUITE J
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5537
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Country | US
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Telephone | 757-484-2382
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Fax | 757-484-2383
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN PATRICK SZAKALY
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Credential | D.D.S
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Telephone | 757-484-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 401411215
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License Number State | VA
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