Healthcare Provider Details

I. General information

NPI: 1760855951
Provider Name (Legal Business Name): BEHL ORTHODODNTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4291 HOLLAND RD STE. 112
VIRGINIA BEACH VA
23452-1939
US

IV. Provider business mailing address

446 EFFINGHAM ST
PORTSMOUTH VA
23704-3464
US

V. Phone/Fax

Practice location:
  • Phone: 757-918-7945
  • Fax:
Mailing address:
  • Phone: 757-325-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410912
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412905
License Number StateVA

VIII. Authorized Official

Name: ALEKSANDRA SOLDO
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-240-5711