Healthcare Provider Details

I. General information

NPI: 1609591981
Provider Name (Legal Business Name): LITTLE DENTAL STUDIO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 LITTLE RIVER TPKE STE 345
ALEXANDRIA VA
22312-5101
US

IV. Provider business mailing address

6303 LITTLE RIVER TPKE STE 345
ALEXANDRIA VA
22312-5101
US

V. Phone/Fax

Practice location:
  • Phone: 703-495-3565
  • Fax:
Mailing address:
  • Phone: 703-942-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA AUSTIN
Title or Position: PRACTICE OWNER
Credential: DMD
Phone: 703-495-3565