Healthcare Provider Details

I. General information

NPI: 1205036464
Provider Name (Legal Business Name): KESHA STEPHENSON-FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N FAYETTE ST
ALEXANDRIA VA
22314-2433
US

IV. Provider business mailing address

224 N FAYETTE ST
ALEXANDRIA VA
22314-2433
US

V. Phone/Fax

Practice location:
  • Phone: 703-519-7275
  • Fax:
Mailing address:
  • Phone: 703-519-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000627
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14059
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: