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General NPI Number Information
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NPI Number | 1558850776
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Entity Type | Organization
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Legal Business Name | EAST COAST CENTRE FOR COSMETIC DENTISTRY AND FACIAL AESTHETICS
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3304 ARCTIC AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2913
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Country | US
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Telephone | 757-481-3305
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Fax | 757-481-7157
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Provider Business Mailing Address
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Address Line | 3304 ARCTIC AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2913
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Country | US
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Telephone | 757-481-3305
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Fax | 757-481-7157
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STANLEY LEROY CHICKEY
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Credential | DDS
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Telephone | 757-481-3305
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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 | 0401005366
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License Number State | VA
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