Dominion Health Medical Associates

NPI #1508110057 in South Boston, Virginia

Provider Information

NPI Number: 1508110057
Entity Type: Organization
Organization Name: Dominion Health Medical Associates
Primary Specialty: Dentist
Enumeration Date: Nov 6, 2012
Last Updated: Nov 6, 2012

Practice Location

Address: 101 AUBREYS LOOP
City: South Boston
State: Virginia
ZIP Code: 24592-5056
Phone: (434) 517-8361

Authorized Official

Name: CECIL HAZELWOOD
Title: MANAGER DHG
Phone: (434) 517-3515

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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