Healthcare Provider Details

I. General information

NPI: 1205206257
Provider Name (Legal Business Name): ALEXANDRIA CHILDREN'S DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 LITTLE RIVER TURNPIKE SUITE 160
ALEXANDRIA VA
22312
US

IV. Provider business mailing address

6303 LITTLE RIVER TURNPIKE SUITE 160
ALEXANDRIA VA
22312
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-8404
  • Fax: 703-890-8726
Mailing address:
  • Phone: 703-942-8404
  • Fax: 703-890-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401411222
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA LANI AUSTIN
Title or Position: PRACTICE OWNER
Credential: DMD
Phone: 703-942-8404