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General NPI Number Information
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NPI Number | 1164999181
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Entity Type | Organization
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Legal Business Name | SMBA DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 2801 MCRAE RD STE C1
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3056
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Country | US
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Telephone | 804-272-9079
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Fax | 804-272-9107
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Provider Business Mailing Address
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Address Line | 2801 MCRAE RD STE C1
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3056
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Country | US
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Telephone | 804-272-9079
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Fax | 804-272-9107
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. SHIVANGI B AMIN
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Credential | DDS, MS
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Telephone | 804-272-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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