Provider Demographics
NPI:1407589351
Name:DELDONNA, PAUL TAZEWELL (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TAZEWELL
Last Name:DELDONNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 CHELMFORD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3118
Mailing Address - Country:US
Mailing Address - Phone:757-544-8845
Mailing Address - Fax:
Practice Address - Street 1:5727 ALLIN RD
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2343
Practice Address - Country:US
Practice Address - Phone:804-862-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist