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General NPI Number Information
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NPI Number | 1568857472
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Entity Type | Organization
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Legal Business Name | CENTER FOR RESTORATIVE, COSMETIC, AND IMPLANT DENTISTRY
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 711 GREENBRIER PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3689
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Country | US
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Telephone | 757-547-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 711 GREENBRIER PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3689
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Country | US
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Telephone | 757-547-2770
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KARYN MONTGOMERY
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Credential |
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Telephone | 757-547-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412179
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License Number State | VA
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