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General NPI Number Information
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NPI Number | 1891126702
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Entity Type | Organization
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Legal Business Name | CENTRE FOR DENTAL EXCELLENCE
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 2008 GENERAL BOOTH BLVD SUITE A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5910
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Country | US
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Telephone | 757-427-7130
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Fax | 757-427-7135
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Provider Business Mailing Address
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Address Line | 2008 GENERAL BOOTH BLVD SUITE A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5910
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Country | US
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Telephone | 757-427-7130
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Fax | 757-427-7135
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS PATRICK DUNHAM
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Credential | DDS
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Telephone | 757-427-7130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007898
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License Number State | VA
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