Provider Demographics
NPI:1437935939
Name:BARRAVINO, BETSY NATIVI (RDH)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:NATIVI
Last Name:BARRAVINO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:CAROLINE
Other - Last Name:NATIVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5522 CONISTONE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1928
Mailing Address - Country:US
Mailing Address - Phone:571-451-5715
Mailing Address - Fax:
Practice Address - Street 1:5803 ROLLING RD STE 211
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1056
Practice Address - Country:US
Practice Address - Phone:703-913-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203966124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist