Healthcare Provider Details

I. General information

NPI: 1831629419
Provider Name (Legal Business Name): HAMPTON ROADS ANESTHESIA & DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 LASKIN RD STE 140
VIRGINIA BEACH VA
23451-5267
US

IV. Provider business mailing address

303 55TH ST UNIT A
VIRGINIA BEACH VA
23451-2213
US

V. Phone/Fax

Practice location:
  • Phone: 757-598-2958
  • Fax: 757-425-1762
Mailing address:
  • Phone: 757-598-2958
  • Fax: 757-425-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0447000045
License Number StateVA

VIII. Authorized Official

Name: DR. JONATHAN LAWRENCE WONG
Title or Position: OWNER
Credential: DMD
Phone: 757-598-2958