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General NPI Number Information
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NPI Number | 1285870188
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Entity Type | Organization
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Legal Business Name | JACQUELINE B SMITH DDS PLLC
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 1385 FORDHAM DR STE 106
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5345
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Country | US
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Telephone | 757-424-0095
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Fax | 757-424-2226
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Provider Business Mailing Address
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Address Line | 1385 FORDHAM DR STE 106
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5345
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Country | US
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Telephone | 757-424-0095
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Fax | 757-424-2226
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JACQUELINE BROWN SMITH
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Credential | D.D.S
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Telephone | 757-424-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401411605
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License Number State | VA
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