MARYBETH FASANO DMD PC NPI 1194905539

NPI Information

MARYBETH FASANO DMD PC is a dental clinic center in Virginia Beach, VA. MARYBETH FASANO DMD PC NPI is 1194905539. The provider is registered as an organization entity type.

The provider's business location address is:

984 FIRST COLONIAL RD
SUITE 200
VIRGINIA BEACH, VA
ZIP 23454-196
Phone: (757) 412-2235
Fax: (757) 412-2237

The provider's authorized official is Shana D Randolph .
The authorized official title is Insurance/financial Coordinator and has the following contact phone number (757) 412-2235.

The enumeration date for this NPI number is 11/13/2007 and was last updated on 11/13/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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