MEDICARE: GOOD NEIGHBOR DENTAL AT GREAT NECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1245612514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NEIGHBOR DENTAL AT GREAT NECK

Provider Business Mailing Address
First Line	:	2865 LYNNHAVEN DR
Second Line	:	SUITE C-4
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1542
Country	:	US
Telephone Number	:	757-481-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 LYNNHAVEN DR
Second Line	:	SUITE C-4
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1542
Country	:	US
Telephone Number	:	757-481-3000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIOS
Name	:	SHERYL A BROWN
Credential	:
Telephone Number	:	757-784-8070

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	06/23/2015

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