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1320 Lasalle Ave Hampton VA 23669-3801 | |
| (757) 727-1140 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 1320 Lasalle Ave, Hampton, Virginia |
| Authorized Official Name and Position | Len Reaves (DENTIST) |
| Authorized Official Contact | 7577271140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3130 Victoria Blvd Hampton VA 23661-1544 Ph: (757) 727-1172 | 1320 Lasalle Ave Hampton VA 23669-3801 Ph: (757) 727-1140 |
| NPI Number | 1407971864 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407971864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 0401005262 (Virginia) | Primary |
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