Healthcare Provider Details

I. General information

NPI: 1770707572
Provider Name (Legal Business Name): ALEXANDRIA ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 MARK CENTER DR SUITE 420
ALEXANDRIA VA
22311
US

IV. Provider business mailing address

4825 MARK CENTER DR SUITE 420
ALEXANDRIA VA
22311
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-3012
  • Fax: 571-512-5856
Mailing address:
  • Phone: 703-370-3012
  • Fax: 571-512-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number05390
License Number StateVA

VIII. Authorized Official

Name: DR. JEFFREY ROTHMAN
Title or Position: OWNER
Credential: DDS
Phone: 703-370-3012