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General NPI Number Information
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NPI Number | 1861688202
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC IMPLANT AND ORAL SURGERY CENTER P.C.
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 3145 VIRGINIA BEACH BLVD SUITE 206
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6950
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Country | US
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Telephone | 757-340-9146
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Fax | 757-340-2547
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Provider Business Mailing Address
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Address Line | 3145 VIRGINIA BEACH BLVD SUITE 206
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6950
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Country | US
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Telephone | 757-340-9146
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Fax | 757-340-2547
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL PAIGE FOLCK II
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Credential | D.D.S.
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Telephone | 757-340-9146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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