Provider Demographics
NPI:1558253286
Name:PHOENIX FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:PHOENIX FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-586-6904
Mailing Address - Street 1:2194 SOUTHAMPTON PKWY
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-6604
Mailing Address - Country:US
Mailing Address - Phone:804-586-6904
Mailing Address - Fax:
Practice Address - Street 1:18197 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BOYKINS
Practice Address - State:VA
Practice Address - Zip Code:23827-2767
Practice Address - Country:US
Practice Address - Phone:804-586-6904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental