Provider Demographics
NPI:1871655571
Name:DIVALENTIN, ROBERT ELIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELIO
Last Name:DIVALENTIN
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 1:9922 LINDEL LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-4034
Mailing Address - Country:US
Mailing Address - Phone:703-281-2370
Mailing Address - Fax:
Practice Address - Street 1:502 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4239
Practice Address - Country:US
Practice Address - Phone:703-281-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice