MEDICARE: BREDOLOGOS FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry	0401007153	VA

General Provider Information

NPI Number	:	1649305467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREDOLOGOS FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1917 LASKIN RD STE 106
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4283
Country	:	US
Telephone Number	:	757-425-1828
Fax Number	:	757-425-1834

Provider Business Practice Location Address
First Line	:	1917 LASKIN RD STE 106
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4283
Country	:	US
Telephone Number	:	757-425-1828
Fax Number	:	757-425-1834

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIA BREDOLOGOS MENDRINOS
Credential	:	D.D.S.
Telephone Number	:	757-425-1828

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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Practice Fax:

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