Provider Demographics
NPI:1265715601
Name:PAUL R. LETELLIER, DDS
Entity type:Organization
Organization Name:PAUL R. LETELLIER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HEBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-436-0026
Mailing Address - Street 1:133 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3701
Mailing Address - Country:US
Mailing Address - Phone:757-436-0026
Mailing Address - Fax:757-547-5658
Practice Address - Street 1:133 KEMPSVILLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3701
Practice Address - Country:US
Practice Address - Phone:757-436-0026
Practice Address - Fax:757-547-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006063305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization