Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 04312 | VA |
Y | 213EG0000X | General Practice | 04312 | VA |
N | 1223P0700X | Prosthodontist | 04312 | VA |
NPI | 1124118534 |
---|---|
Provider Name | Dr. Joseph Nello Tregaskes |
First Address | Richmond, VA 23226 |
Second Address | Richmond, VA 23226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 07/08/2007 |