Individual
PETER HAVELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
441 E MAIN ST, PURCELLVILLE, VA 20132
(703) 300-7332
Mailing address
PO BOX 300, PURCELLVILLE, VA 20134-0300
(540) 338-7325
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401415630
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2016
Last updated
10/08/2018
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