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>> Dentist >> Dental Providers

Registrant NPI Number: 1093709685

Individual Registrant:
Gender: M

Location and contact information for practice:
Tel: 202-767-5626  Fax: --

Contact information for business:
1120 ALDEN RD  ALEXANDRIA, VA 22308-2554 US
Tel: 703-799-6614  Fax: --

Registration Information:
NPI: 1093709685
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Legacy codes, insurance codes and state license numbers:



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