Individual
MALOY LYNN VAN FAUSSIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
7400 GRANBY ST STE B, NORFOLK, VA 23505-3436
(757) 587-7400
Mailing address
7400 GRANBY ST STE B, NORFOLK, VA 23505-3436
(757) 587-7400
(757) 675-9665
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402003803
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0402003803
DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
08/18/2025
Last updated
08/18/2025
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