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General NPI Number Information
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NPI Number | 1407971864
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Entity Type | Organization
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Legal Business Name | VIRGINIA DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1320 LASALLE AVE
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City | HAMPTON
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State | VA
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Zip | 23669-3801
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Country | US
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Telephone | 757-727-1140
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 VICTORIA BLVD
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City | HAMPTON
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State | VA
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Zip | 23661-1544
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Country | US
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Telephone | 757-727-1172
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Fax | 757-727-1185
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LEN REAVES I
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Credential | DDS
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Telephone | 757-727-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 0401005262
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License Number State | VA
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