Healthcare Provider Details

I. General information

NPI: 1457561631
Provider Name (Legal Business Name): KARI ANNE DYER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MONTGOMERY ST SUITE 205
ALEXANDRIA VA
22314-1565
US

IV. Provider business mailing address

6022 WENDRON WAY
ALEXANDRIA VA
22315-2600
US

V. Phone/Fax

Practice location:
  • Phone: 703-836-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402204016
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: