Healthcare Provider Details

I. General information

NPI: 1225285307
Provider Name (Legal Business Name): LESLIE JOHN FINA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JESSIE DUPONT MEMORIAL HIGHWAY
BURGESS VA
22432-0277
US

IV. Provider business mailing address

PO BOX 277
BURGESS VA
22432-0277
US

V. Phone/Fax

Practice location:
  • Phone: 804-453-3101
  • Fax: 804-453-3450
Mailing address:
  • Phone: 804-453-3101
  • Fax: 804-453-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02383900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: