Provider Demographics
NPI:1407971864
Name:VIRGINIA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:VIRGINIA DEPARTMENT OF HEALTH
Other - Org Name:HAMPTON HEALTH DEPARTMENT DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-727-1140
Mailing Address - Street 1:3130 VICTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-1544
Mailing Address - Country:US
Mailing Address - Phone:757-727-1172
Mailing Address - Fax:757-727-1185
Practice Address - Street 1:1320 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3801
Practice Address - Country:US
Practice Address - Phone:757-727-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052621223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty