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Contact Information

CHILDRENS ENDODONTIC SERVICES, PC
2010 WAKEFIELD AVE
PETERSBURG, VA23805-2112
 Phone: 804-733-6740
 Fax: 804-733-8687
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for CHILDRENS ENDODONTIC SERVICES PC · (Female)

NPI Number 1750403911
Status Active
Credentials
Entity Individual
Enumeration date 04/06/2007
Last updated 11/07/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • VA License # 0401412670
  • FL Medicaid 004708800
  • KY Medicaid 45003936
  • KY Medicaid 60003308
  • TN Medicaid 3225803
  • VA Medicaid 1184607756
  • DC Other DEN1000852 WASHINGTON DC DENTAL LICENSE
  • FL Other DN19669 FLORIDA LIMITED DENTAL LICENSE
  • TN Other 5360 TENNESSEE DENTAL LICENSE
  • VA Other 0401412670 VIRGINIA DENTAL LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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