Provider Demographics
NPI:1457980658
Name:MARIONEAUX, HAROLD J JR
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:J
Last Name:MARIONEAUX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 OPPORTUNITY WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2003
Mailing Address - Country:US
Mailing Address - Phone:757-258-6597
Mailing Address - Fax:
Practice Address - Street 1:504 MILL STONE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4367
Practice Address - Country:US
Practice Address - Phone:757-573-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice