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General NPI Number Information
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NPI Number | 1881087690
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Entity Type | Organization
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Legal Business Name | SMITHFIEL DENTAL PC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 12746 COURTHOUSE HWY
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City | SMITHFIELD
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State | VA
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Zip | 23430-7117
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Country | US
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Telephone | 757-357-6779
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Fax | 757-357-2722
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Provider Business Mailing Address
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Address Line | 12746 COURTHOUSE HWY
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City | SMITHFIELD
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State | VA
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Zip | 23430-7117
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Country | US
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Telephone | 757-357-6779
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Fax | 757-357-2722
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MS. ASHLEY FALLON DUCK
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Credential |
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Telephone | 757-357-6779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006344
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412524
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License Number State | VA
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