Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401413616 | VA |
N | 1223D0001X | Dental Public Health | 0401413116 | VA |
N | 1223G0001X | General Practice | 0401413616 | VA |
N | 213EG0000X | General Practice | 0401413616 | VA |
NPI | 1366704397 |
---|---|
Provider Name | Dr. Emily M Dimitroff |
First Address | Chesapeake, VA 23322-7492 |
Second Address | Chesapeake, VA 23322-7492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 11/10/2021 |