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General NPI Number Information
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NPI Number | 1124913561
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Entity Type | Organization
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Legal Business Name | CREATING NEW SMILES ASC, LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1682 CHURCH ST
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City | NORFOLK
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State | VA
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Zip | 23504-2346
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Country | US
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Telephone | 757-683-0143
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Fax | 757-901-0613
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Provider Business Mailing Address
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Address Line | 4936 LIMESTONE AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIM ERVIL
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Credential | DDS
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Telephone | 804-615-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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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 |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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