MEDICARE: DR. CHRISTOPHER JAMES LUEVANO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401415060	VA
2	122300000X	Dentist	60423	CA
3	1223P0221X	Pediatric Dentistry	0401415060	VA
4	1223P0221X	Pediatric Dentistry	60423	CA

General Provider Information

NPI Number	:	1386923464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JAMES LUEVANO D.D.S.

Provider Business Mailing Address
First Line	:	9225 DOERR RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 DOERR RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	03/22/2023

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