Provider Demographics
NPI:1568218717
Name:TOWN CENTER PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity type:Organization
Organization Name:TOWN CENTER PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-869-9916
Mailing Address - Street 1:4525 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7793
Mailing Address - Country:US
Mailing Address - Phone:757-369-1754
Mailing Address - Fax:757-234-8891
Practice Address - Street 1:4525 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7793
Practice Address - Country:US
Practice Address - Phone:757-369-1754
Practice Address - Fax:757-234-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty