Provider Demographics
NPI:1487527412
Name:PELUSO, ANTHONY R (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:PELUSO
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 1:302 E LITTLE CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2645
Mailing Address - Country:US
Mailing Address - Phone:757-583-2333
Mailing Address - Fax:754-480-2555
Practice Address - Street 1:302 E LITTLE CREEK RD STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2645
Practice Address - Country:US
Practice Address - Phone:757-583-2333
Practice Address - Fax:754-480-2555
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty