Provider Demographics
NPI:1770023210
Name:SOFT PALATE DENTISTRY
Entity Type:Organization
Organization Name:SOFT PALATE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:484-226-7023
Mailing Address - Street 1:PO BOX 14186
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-0186
Mailing Address - Country:US
Mailing Address - Phone:757-651-2082
Mailing Address - Fax:407-479-3846
Practice Address - Street 1:1734 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4202
Practice Address - Country:US
Practice Address - Phone:757-651-2082
Practice Address - Fax:407-479-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty