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General NPI Number Information
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NPI Number | 1144094475
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Entity Type | Organization
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Legal Business Name | A-Z TOTAL DENTAL ART STUDIO, PLLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 10220 STAPLES MILL RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3064
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Country | US
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Telephone | 804-767-2507
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Fax | 804-767-2571
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Provider Business Mailing Address
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Address Line | 10220 STAPLES MILL RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3064
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Country | US
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Telephone | 804-767-2507
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Fax | 804-767-2571
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Authorized Official
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Title or Position | OWNER
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Name | DR. ASHLEE P GOODMAN-TABARI
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Credential | DMD
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Telephone | 804-767-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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