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General NPI Number Information
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NPI Number | 1427319300
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Entity Type | Organization
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Legal Business Name | THE FOLECK CENTER
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 201 COLLEGE PLACE #111
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City | NORFOLK
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State | VA
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Zip | 23510
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Country | US
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Telephone | 757-623-0283
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Fax | 757-623-0339
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Provider Business Mailing Address
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Address Line | 201 COLLEGE PLACE #111
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City | NORFOLK
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State | VA
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Zip | 23510
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Country | US
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Telephone | 757-623-0283
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Fax | 757-623-0339
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Authorized Official
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Title or Position | CEO
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Name | TATJANA MANOJLOVIC
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Credential |
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Telephone | 757-623-0283
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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 | 0401412033
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412834
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401413140
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401008873
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License Number State | VA
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