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General NPI Number Information
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NPI Number | 1265715601
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Entity Type | Organization
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Legal Business Name | PAUL R. LETELLIER, DDS
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 133 KEMPSVILLE RD SUITE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3701
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Country | US
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Telephone | 757-436-0026
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Fax | 757-547-5658
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Provider Business Mailing Address
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Address Line | 133 KEMPSVILLE RD SUITE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3701
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Country | US
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Telephone | 757-436-0026
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Fax | 757-547-5658
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PATRICIA LYNN HEBERLING
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Credential |
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Telephone | 757-436-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0401006063
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License Number State | VA
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