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General NPI Number Information
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NPI Number | 1528457488
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Entity Type | Organization
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Legal Business Name | GOOD NEIGHBOR DENTAL AT EDINBURGH
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 236 CARMICHAEL WAY SUITE 312
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City | CHESAPEAKE
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State | VA
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Zip | 23322-2185
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Country | US
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Telephone | 757-932-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 236 CARMICHAEL WAY SUITE 312
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City | CHESAPEAKE
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State | VA
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Zip | 23322-2185
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Country | US
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Telephone | 757-932-5200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. SHERYL ANNE BROWN
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Credential |
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Telephone | 757-784-8070
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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 | 0401007257
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License Number State | VA
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