Provider Demographics
NPI:1053856468
Name:WILLIAMSBURG CENTER FOR DENTAL HEALTH
Entity Type:Organization
Organization Name:WILLIAMSBURG CENTER FOR DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-565-6303
Mailing Address - Street 1:5231 MONTICELLO AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8300
Mailing Address - Country:US
Mailing Address - Phone:757-565-6303
Mailing Address - Fax:
Practice Address - Street 1:5231 MONTICELLO AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8300
Practice Address - Country:US
Practice Address - Phone:757-565-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty