| NPI | 1700631801 |
|---|---|
| Doing Business As | COLISEUM PEDIATRIC DENTISTRY SURGERY CENTER |
| Entity Type | Organization |
| Authorized Contact | CHRIS CANNON Rcm 757-327-4843 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |