Provider Demographics
NPI:1841177466
Name:VAN FAUSSIEN, MALOY LYNN (RDH)
Entity type:Individual
Prefix:
First Name:MALOY
Middle Name:LYNN
Last Name:VAN FAUSSIEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:MALOY
Other - Middle Name:LYNN
Other - Last Name:HEISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7400 GRANBY ST STE B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3436
Mailing Address - Country:US
Mailing Address - Phone:757-587-7400
Mailing Address - Fax:757-675-9665
Practice Address - Street 1:7400 GRANBY ST STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3436
Practice Address - Country:US
Practice Address - Phone:757-587-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402003803124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0402003803OtherDEPARTMENT OF HEALTH PROFESSIONS