| Pungoteague Elementary School Dental Program | |
|
28480 Bobtown Rd Melfa VA 23410-3508 | |
| (757) 789-7777 | |
| (757) 789-7778 |
| Full Name | Pungoteague Elementary School Dental Program |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 28480 Bobtown Rd, Melfa, Virginia |
| Authorized Official Name and Position | Jeannette Edwards (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7574140400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pungoteague Elementary School Dental Program 20280 Market St Onancock VA 23417-1331 Ph: (757) 414-0400 | Pungoteague Elementary School Dental Program 28480 Bobtown Rd Melfa VA 23410-3508 Ph: (757) 789-7777 |
| NPI Number | 1881847135 |
|---|---|
| Provider Enumeration Date | 10/30/2008 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881847135 | NPI | - | NPPES |
| 008450552 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |