Peninsula Pediatric Dentistry, P.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0401410912 Issued in VA

Legal business name

PENINSULA PEDIATRIC DENTISTRY, P.C.

Practice address

220 Nat Turner Boulevard S
Newport News, VA 23606

Phone

(757) 240-5711

Fax

(757) 240-4939

NPI assigned

May 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grace O Davis

Title

Business Administrator

Phone

(757) 369-1754

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1548477649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 NAT TURNER BOULEVARD S",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 NAT TURNER BOULEVARD S",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23606",
            "telephone_number": "757-240-5711",
            "fax_number": "757-240-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PEDIATRIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "757-369-1754"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401410912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peninsula Pediatrics LTD
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• Peninsula Pulmonary Associates PC

• All providers in Newport News, VA
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.