Healthcare Provider Details

I. General information

NPI: 1942299755
Provider Name (Legal Business Name): GARY VAHAN AVAKIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S COLUMBUS ST
ALEXANDRIA VA
22314-3603
US

IV. Provider business mailing address

303 S COLUMBUS ST
ALEXANDRIA VA
22314-3603
US

V. Phone/Fax

Practice location:
  • Phone: 703-549-7492
  • Fax:
Mailing address:
  • Phone: 703-549-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5154
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: