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General NPI Number Information
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NPI Number | 1972054773
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Entity Type | Organization
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Legal Business Name | ANTONE EXUM DDS
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 10124 W BROAD ST STE Q
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3330
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Country | US
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Telephone | 804-212-2501
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Fax | 804-887-6238
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Provider Business Mailing Address
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Address Line | 10124 W BROAD ST STE Q
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3330
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Country | US
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Telephone | 804-212-2501
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Fax | 804-887-6238
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ANTONE C EXUM
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Credential | DDS
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Telephone | 804-212-2501
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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 | 0401006994
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License Number State | VA
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