=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902885668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ANTHONY BITONTI D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2006
-----------------------------------------------------
Last Update Date | 08/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 RIVERVIEW AVE
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-668-7713
-----------------------------------------------------
Fax | 757-668-7711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4012 LAMBS CREEK CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23455-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-937-0218
-----------------------------------------------------
Fax | 757-937-0218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | DS-024817-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | 0401418436
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 0401418436
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------