Individual
REYNALDO LORENZO PELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4625 VIRGINIA BEACH BLVD, VIRGINIA BEACH, VA 23462-6795
(757) 807-2137
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401417388
VA
1223G0001X
General Practice Dentistry
Primary
0401417388
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2020
Last updated
06/04/2021
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