Healthcare Provider Details

I. General information

NPI: 1639142441
Provider Name (Legal Business Name): JAMES HENRY GHERARDINI JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 TAUSSIG BLVD
NORFOLK VA
23511
US

IV. Provider business mailing address

1819 QUIVERS KEEP
CHESAPEAKE VA
23321
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-6516
  • Fax:
Mailing address:
  • Phone: 757-405-9548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2717
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number38001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: