Provider Demographics
NPI:1417347154
Name:THE PETERSBURG SMILE CENTER, P.C.
Entity Type:Organization
Organization Name:THE PETERSBURG SMILE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:TOWANA
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-732-8800
Mailing Address - Street 1:34 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9283
Mailing Address - Country:US
Mailing Address - Phone:804-732-8800
Mailing Address - Fax:804-732-8801
Practice Address - Street 1:34 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9283
Practice Address - Country:US
Practice Address - Phone:804-732-8800
Practice Address - Fax:804-732-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty