=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871615567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KESSLER & KESSLER DENTISTRY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2404 POTTERS RD SUITE 400
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-340-8805
-----------------------------------------------------
Fax | 757-340-8803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2404 POTTERS RD SUITE 400
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-340-8805
-----------------------------------------------------
Fax | 757-340-8803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. TIFFANY F. KESSLER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 757-340-8805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------