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General NPI Number Information
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NPI Number | 1760771679
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Entity Type | Organization
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Legal Business Name | PENINSULA ORTHODONTICS, PC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 401 OYSTER POINT RD SUITE D
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-6926
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Country | US
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Telephone | 757-249-4203
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Fax | 757-249-4208
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Provider Business Mailing Address
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Address Line | 401 OYSTER POINT RD SUITE D
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-6926
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Country | US
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Telephone | 757-249-4203
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Fax | 757-249-4208
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICKI ROSS
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Credential | DMD
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Telephone | 757-249-4203
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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 | 7301
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License Number State | VA
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