Provider Demographics
NPI:1033455449
Name:WILLIAMSBURG PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:WILLIAMSBURG PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARALAMBOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROFALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-240-5711
Mailing Address - Street 1:5388 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8218
Mailing Address - Country:US
Mailing Address - Phone:757-259-9703
Mailing Address - Fax:
Practice Address - Street 1:220 NAT TURNER BLVD S
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2899
Practice Address - Country:US
Practice Address - Phone:757-240-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty