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General NPI Number Information
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NPI Number | 1760766737
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Entity Type | Organization
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Legal Business Name | KLARVOORHEES ORTHODONTICS
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 5241 PROVIDENCE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4201
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Country | US
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Telephone | 757-495-3110
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Fax | 757-495-7722
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Provider Business Mailing Address
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Address Line | 5241 PROVIDENCE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4201
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Country | US
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Telephone | 757-495-3110
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Fax | 757-495-7722
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Authorized Official
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Title or Position | VICE PRESIDENT AND ORTHODONTIST
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Name | DR. MARNI VOORHEES HUSSON
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Credential | DDS
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Telephone | 757-495-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401102544
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License Number State | VA
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