Healthcare Provider Details

I. General information

NPI: 1720069974
Provider Name (Legal Business Name): GIUSEPPE REBELLATO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PANTOPS MOUNTAIN PL
CHARLOTTESVILLE VA
22911-4662
US

IV. Provider business mailing address

1470 PANTOPS MOUNTAIN PL
CHARLOTTESVILLE VA
22911-4662
US

V. Phone/Fax

Practice location:
  • Phone: 434-984-1817
  • Fax: 434-817-1819
Mailing address:
  • Phone: 434-984-1817
  • Fax: 434-817-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401007829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: