Provider Demographics
NPI:1568574648
Name:LAVECCHIA, GREGORY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:LAVECCHIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WILSON BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209
Mailing Address - Country:US
Mailing Address - Phone:703-528-3336
Mailing Address - Fax:703-524-2206
Practice Address - Street 1:1515 WILSON BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209
Practice Address - Country:US
Practice Address - Phone:703-528-3336
Practice Address - Fax:703-524-2206
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice