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General NPI Number Information
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NPI Number | 1679215834
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Entity Type | Organization
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Legal Business Name | JOELLE HAIRSTON DDS PLLC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 107 BULIFANTS BLVD
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5710
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Country | US
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Telephone | 757-941-4441
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Fax | 757-941-4448
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Provider Business Mailing Address
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Address Line | 8105 HELMSDALE CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-6644
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Country | US
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Telephone | 912-661-2100
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOELLE LAQUITA MARIE HAIRSTON
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Credential | DDS
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Telephone | 912-661-2100
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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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