Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401415004 | VA |
NPI | 1033478375 |
---|---|
Provider Name | Dr. Angelo Gayheart Pope JR. |
First Address | Chesapeake, VA 23324-3707 |
Second Address | Winchester, VA 22601-3346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 22/06/2021 |