1639405558 NPI number — ACKERMAN & ASSOCIATES OF ALEXANDRIA, DDS, LLC

Table of content: (NPI 1639405558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639405558 NPI number — ACKERMAN & ASSOCIATES OF ALEXANDRIA, DDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACKERMAN & ASSOCIATES OF ALEXANDRIA, DDS, 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:
1639405558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 SEMINARY RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22311-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-931-0200
Provider Business Mailing Address Fax Number:
703-931-0209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5055 SEMINARY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22311-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-931-0200
Provider Business Practice Location Address Fax Number:
703-931-0209
Provider Enumeration Date:
10/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ACKERMAN
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/ DENTIST
Authorized Official Telephone Number:
703-931-0200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  401004044 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401007743 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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