1518254432 NPI number — DENTAL ASSOCIATES OF NORTHERN VIRGINIA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518254432 NPI number — DENTAL ASSOCIATES OF NORTHERN VIRGINIA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL ASSOCIATES OF NORTHERN VIRGINIA PLLC
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:
1518254432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 FAIR LAKES CIR
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-4910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-269-3107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5113 LEESBURG PIKE
Provider Second Line Business Practice Location Address:
FOUR SKYLINE PLACE, UNIT 811
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22041-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-269-3107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FINK
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
703-269-3107

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401003843 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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