Provider Demographics
NPI:1457431223
Name:RADEVA, KAMELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMELIA
Middle Name:
Last Name:RADEVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 PUMP RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5540
Mailing Address - Country:US
Mailing Address - Phone:804-740-0834
Mailing Address - Fax:
Practice Address - Street 1:1006 PUMP RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-5540
Practice Address - Country:US
Practice Address - Phone:804-740-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice