Healthcare Provider Details

I. General information

NPI: 1255278065
Provider Name (Legal Business Name): MAXILLOFACIAL SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

PO BOX 21
NASSAWADOX VA
23413-0021
US

V. Phone/Fax

Practice location:
  • Phone: 915-499-0386
  • Fax:
Mailing address:
  • Phone: 757-919-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD F MATTHEWS JR.
Title or Position: BILLING MANAGER
Credential:
Phone: 757-894-4329