Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 29941 | TX |
Y | 1223E0200X | Endodontist | 0401415976 | VA |
NPI | 1114333804 |
---|---|
Provider Name | Dr. Valeria Pizzini |
First Address | Chesapeake, VA 23320-8489 |
Second Address | Chesapeake, VA 23320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 31/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0401415976 | DENTAL LICENSE (01) | VA |