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General NPI Number Information
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NPI Number | 1700165974
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Entity Type | Organization
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Legal Business Name | HOWARD A. MENDELSOHN D.D.S, PC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 6095 INDIAN RIVER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3818
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Country | US
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Telephone | 757-424-1976
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Fax | 757-424-3152
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Provider Business Mailing Address
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Address Line | 6095 INDIAN RIVER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3818
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Country | US
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Telephone | 757-424-1976
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Fax | 757-424-3152
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | HOWARD A MENDELSOHN
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Credential | DDS
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Telephone | 757-424-1976
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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 | 0401003992
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License Number State | VA
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