Individual
DR. ROBERT ELIO DIVALENTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
502 MAPLE AVE W, VIENNA, VA 22180-4239
(703) 281-0800
Mailing address
9922 LINDEL LN, VIENNA, VA 22181-4034
(703) 281-2370
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401004403
VA
Other
Enumeration date
12/16/2006
Last updated
07/08/2007
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