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General NPI Number Information
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NPI Number | 1174093835
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Entity Type | Organization
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Legal Business Name | PATRIOT ORAL AND FACIAL SURGERY PLLC
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 121 BULIFANTS BLVD STE B
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5736
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Country | US
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Telephone | 757-297-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 121 BULIFANTS BLVD STE B
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5736
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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 | CREDENTIALING
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Name | LORI A WASHNIGTON
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Credential |
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Telephone | 757-595-8964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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