Provider Demographics
NPI:1457897431
Name:ALL KIDS DENTAL OF SUFFOLK PC
Entity Type:Organization
Organization Name:ALL KIDS DENTAL OF SUFFOLK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-922-8110
Mailing Address - Street 1:2999 CORPORATE LANE
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2999 CORPORATE LN
Practice Address - Street 2:SUITE B-8
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8478
Practice Address - Country:US
Practice Address - Phone:804-267-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty