Provider Demographics
NPI:1831395623
Name:LAXA, ADRIAN M (DDS)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:M
Last Name:LAXA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4540 PRINCESS ANNE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-497-0450
Mailing Address - Fax:757-497-6137
Practice Address - Street 1:4540 PRINCESS ANNE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-497-0450
Practice Address - Fax:757-497-6137
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04014118411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice