Provider Demographics
NPI:1609274836
Name:CITY OF NEWPORT NEWS
Entity Type:Organization
Organization Name:CITY OF NEWPORT NEWS
Other - Org Name:CITY OF NEWPORT NEWS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:VANSICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-933-2369
Mailing Address - Street 1:416 J CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1927
Mailing Address - Country:US
Mailing Address - Phone:757-933-2369
Mailing Address - Fax:
Practice Address - Street 1:416 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1927
Practice Address - Country:US
Practice Address - Phone:757-933-2369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare