institution
Pediatric Dental Care Of Tidewater Pc
Pediatric Dentist in Portsmouth, Virginia
NPI 1891915112

Pediatric Dental Care Of Tidewater Pc is a Pediatric Dentist based in Portsmouth, VA and is specialized in Pediatric Dentistry. Pediatric Dental Care Of Tidewater Pc practices in Portsmouth, VA. The NPI Number for Pediatric Dental Care Of Tidewater Pc is 1891915112 and holds a License No. 0401410496 (Virginia).

The current practice location address for Pediatric Dental Care Of Tidewater Pc is 5915 High Street West, Portsmouth, VA and can be reached out via phone at 757-484-8262 and via fax at 757-638-3632.

Location: 5915 High Street West, Portsmouth, VA, 23703-4505
institution
Provider Profile Details
NPI Number
1891915112
Provider Name
Pediatric Dental Care Of Tidewater Pc
Credential
Provider Entity Type
Organization
Address
5915 High Street West, Portsmouth, VA, 23703-4505
Phone Number
757-484-8262
Fax Number
757-638-3632
Provider Enumeration Date
04/27/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
249681 01 ANTHEM
1702520 01 UNITED CONCORDIA
institution
Provider Business Practice Location Address Details
Address
5915 High Street West
City
State
Zip
23703
Phone Number
757-484-8262
Fax Number
757-638-3632
person
Provider Business Mailing Address Details
Address
5915 High Street West
City
State
Zip
23703
Phone Number
757-484-8262
Fax Number
757-638-3632
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
License No.
0401410496 (Virginia)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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