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General NPI Number Information
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NPI Number | 1720237811
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Entity Type | Organization
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Legal Business Name | PARTNERS IN DENTAL HEALTH II
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 738 E BAYVIEW BLVD STE 3
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City | NORFOLK
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State | VA
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Zip | 23503-5447
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Country | US
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Telephone | 757-588-1563
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Fax | 757-962-5318
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Provider Business Mailing Address
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Address Line | 738 E BAYVIEW BLVD STE 3
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City | NORFOLK
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State | VA
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Zip | 23503-5447
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Country | US
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Telephone | 757-588-1563
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Fax | 757-962-5318
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Authorized Official
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Title or Position | PARTNER
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Name | KEENAN M DAVIS
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Credential | DDS
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Telephone | 757-588-1563
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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 | 0401411811
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401006401
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0401008797
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005418
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License Number State | VA
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