MEDICARE: CRANIAL FACIAL IMAGING CENTER LLC

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	0401007138	VA

General Provider Information

NPI Number	:	1821298670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANIAL FACIAL IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	7151 RICHMOND RD
Second Line	:	SUITE 306
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7234
Country	:	US
Telephone Number	:	757-476-6714
Fax Number	:	757-476-6715

Provider Business Practice Location Address
First Line	:	7151 RICHMOND RD
Second Line	:	SUITE 306
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7234
Country	:	US
Telephone Number	:	757-476-6714
Fax Number	:	757-476-6715

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT F MORRISON JR.
Credential	:	DMD
Telephone Number	:	757-476-6714

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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