Healthcare Provider Details

I. General information

NPI: 1962253492
Provider Name (Legal Business Name): NATHAN ANDREW FIGUEROA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WINDSOR CIR
BLUEFIELD VA
24605-9323
US

IV. Provider business mailing address

112 WINDSOR CIR
BLUEFIELD VA
24605-9323
US

V. Phone/Fax

Practice location:
  • Phone: 304-888-2064
  • Fax:
Mailing address:
  • Phone: 304-888-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI0308200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: