Healthcare Provider Details

I. General information

NPI: 1568797413
Provider Name (Legal Business Name): EXQUISITE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2009
Last Update Date: 10/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WASHINGTON ST STE 210
ALEXANDRIA VA
22314-2530
US

IV. Provider business mailing address

300 N WASHINGTON ST STE 210
ALEXANDRIA VA
22314-2530
US

V. Phone/Fax

Practice location:
  • Phone: 202-659-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411050
License Number StateVA

VIII. Authorized Official

Name: DR. DONNA REID
Title or Position: PRESIDENT
Credential:
Phone: 202-659-3500