Provider Demographics
NPI:1649895863
Name:DERENZI, ALLISON (DDS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DERENZI
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 1:1533 VOLVO PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8490
Mailing Address - Country:US
Mailing Address - Phone:757-918-7828
Mailing Address - Fax:
Practice Address - Street 1:1533 VOLVO PKWY STE 250
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8490
Practice Address - Country:US
Practice Address - Phone:757-918-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014187971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery