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General NPI Number Information
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NPI Number | 1548376361
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Entity Type | Organization
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Legal Business Name | BRUCE H. UTTERBACK, DMD AND PIA ARAGON SWEENEY, DDS, PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 814 NEWTOWN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-1116
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Country | US
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Telephone | 757-490-0419
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Fax | 757-490-0870
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Provider Business Mailing Address
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Address Line | 814 NEWTOWN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-1116
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Country | US
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Telephone | 757-490-0419
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Fax | 757-490-0870
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE HAROLD UTTERBACK
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Credential | DMD
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Telephone | 757-490-0419
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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 | VA401007145
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License Number State | VA
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