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General NPI Number Information
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NPI Number | 1134738354
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Entity Type | Organization
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Legal Business Name | DENTISTRY BY DESIGN COLONIAL HEIGHTS PLLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 241 CHARLES H DIMMOCK PKWY STE 2
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2915
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Country | US
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Telephone | 804-520-0699
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Fax |
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Provider Business Mailing Address
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Address Line | 13580 GROUPE DR STE 305
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4165
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Country | US
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Telephone | 703-304-1276
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Fax |
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Authorized Official
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Title or Position | FINANCE COORDINATOR
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Name | MS. KRYSTAL D FLOWERS
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Credential |
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Telephone | 703-304-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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