NPI:
1801067285
Provider Name:
SOUTHSIDE ORAL & FACIAL SURGERY
Former Legal Business Name: DRS. O'NEILL, TROTTER & BRINSER
Classification:
Dentist - 1223S0112X
Entity Type:
Organization
Specialization: Oral and Maxillofacial Surgery
CLIA Number: 49D2155852
Address:
11971 IRON BRIDGE RD
CHESTER, VA
ZIP 23831
Phone:
(804) 717-5275
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SOUTHSIDE ORAL & FACIAL SURGERY is an oral and maxillofacial surgery dentist in Chester, VA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SOUTHSIDE ORAL & FACIAL SURGERY NPI is 1801067285. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Drs. O'neill, Trotter & Brinser.
The provider's business location address is:
11971 IRON BRIDGE RD
CHESTER, VA
ZIP 23831-458
Phone: (804) 717-5275
Fax: (804) 748-4017
The provider's authorized official is Bradley Scott Trotter .
The authorized official title is Dentist and has the following contact phone number (804) 717-5275.
The CLIA number assigned to this NPI record is 49D2155852 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/13/2008 and was last updated on 3/13/2008.