Provider Demographics
NPI:1902257082
Name:VICTORY SMILES OF VIRGINIA
Entity Type:Organization
Organization Name:VICTORY SMILES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-787-3434
Mailing Address - Street 1:1405 WESTOVER HILLS BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3153
Mailing Address - Country:US
Mailing Address - Phone:804-505-0337
Mailing Address - Fax:
Practice Address - Street 1:1405 WESTOVER HILLS BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3153
Practice Address - Country:US
Practice Address - Phone:804-505-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental