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General NPI Number Information
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NPI Number | 1609274836
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Entity Type | Organization
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Legal Business Name | CITY OF NEWPORT NEWS
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 416 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1927
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Country | US
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Telephone | 757-933-2369
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Fax |
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Provider Business Mailing Address
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Address Line | 416 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1927
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Country | US
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Telephone | 757-933-2369
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MR. PETER D VANSICKELS
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Credential | DDS
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Telephone | 757-933-2369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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