Provider Demographics
NPI:1205253978
Name:DR. PATRICIA REATEGUI D.D.S.P.C.
Entity type:Organization
Organization Name:DR. PATRICIA REATEGUI D.D.S.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REATEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDSPC
Authorized Official - Phone:540-659-6650
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0279
Mailing Address - Country:US
Mailing Address - Phone:540-659-6650
Mailing Address - Fax:540-657-0576
Practice Address - Street 1:623 GARRISONVILLE RD
Practice Address - Street 2:623 GARRISONVILLE ROAD
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3710
Practice Address - Country:US
Practice Address - Phone:540-659-6650
Practice Address - Fax:540-657-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty