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General NPI Number Information
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NPI Number | 1427550318
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Entity Type | Organization
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Legal Business Name | BLUE COMFORT DENTAL PC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 3277 S CRATER RD STE C
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City | PETERSBURG
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State | VA
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Zip | 23805-9285
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Country | US
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Telephone | 804-733-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 1671 HIGHLANDON CT
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City | STATE COLLEGE
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State | PA
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Zip | 16801-4356
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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 | PRESIDENT
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Name | THUY-VAN NGUYEN
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Credential |
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Telephone | 571-338-3736
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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 | 0401415827
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License Number State | VA
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