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General NPI Number Information
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NPI Number | 1487362554
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Entity Type | Organization
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Legal Business Name | DANIEL TIESWORTH DDS
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 11435 ROBIOUS RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4309
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Country | US
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Telephone | 804-330-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 PONDOLA LN
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-1636
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Country | US
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Telephone | 804-897-3600
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Fax |
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Authorized Official
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Title or Position | ASSISTANT
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Name | LAURI HENDERSON
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Credential |
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Telephone | 804-897-3600
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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 |
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License Number State |
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