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General NPI Number Information
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NPI Number | 1558253286
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 18197 VIRGINIA AVE
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City | BOYKINS
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State | VA
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Zip | 23827-2767
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Country | US
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Telephone | 804-586-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 2194 SOUTHAMPTON PKWY
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City | EMPORIA
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State | VA
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Zip | 23847-6604
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Country | US
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Telephone | 804-586-6904
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JACQUELINE BROWN
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Credential | DDS
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Telephone | 804-586-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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