Provider Demographics
NPI:1124572417
Name:ISLE OF WIGHT FAMILY & COSMETIC DENTISTRY PC
Entity Type:Organization
Organization Name:ISLE OF WIGHT FAMILY & COSMETIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SZAKALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-484-2382
Mailing Address - Street 1:4053 TAYLOR RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5537
Mailing Address - Country:US
Mailing Address - Phone:757-484-2382
Mailing Address - Fax:757-484-2383
Practice Address - Street 1:4053 TAYLOR RD
Practice Address - Street 2:SUITE J
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5537
Practice Address - Country:US
Practice Address - Phone:757-484-2382
Practice Address - Fax:757-484-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401411215261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery