Healthcare Provider Details

I. General information

NPI: 1730226648
Provider Name (Legal Business Name): DR'S FORD, GUTER, & RAI, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 GREENWICH RD
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

5720 GREENWICH RD
VIRGINIA BEACH VA
23462
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-6886
  • Fax: 757-499-3464
Mailing address:
  • Phone: 757-499-6886
  • Fax: 757-499-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401-006024
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401-410256
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401-410239
License Number StateVA

VIII. Authorized Official

Name: MRS. SUSAN REASON
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-499-6886