Provider Demographics
NPI:1417722281
Name:BUESO, DENNIS EDUARDO (RD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:EDUARDO
Last Name:BUESO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7973
Mailing Address - Country:US
Mailing Address - Phone:757-724-2767
Mailing Address - Fax:
Practice Address - Street 1:6201 E VIRGINIA BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2807
Practice Address - Country:US
Practice Address - Phone:757-624-0600
Practice Address - Fax:757-461-3246
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist