1073481891 NPI number — RXWELLNESS AESTHETICS & ANTI-AGING LLC

Table of content: DR. ALAN VAN DILSAVER DDS (NPI 1639215254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073481891 NPI number — RXWELLNESS AESTHETICS & ANTI-AGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RXWELLNESS AESTHETICS & ANTI-AGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073481891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 HERNDON PKWY STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20170-5526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-569-6546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 HERNDON PKWY STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-5526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-569-6546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
CASEY
Authorized Official First Name:
THUY
Authorized Official Middle Name:
PHOEBE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
571-569-6546

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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