Healthcare Provider Details

I. General information

NPI: 1477695161
Provider Name (Legal Business Name): KATHERINE MEI VROOM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 EVERGREEN COURT
ANNANDALE VA
22003
US

IV. Provider business mailing address

7027 EVERGREEN COURT
ANNANDALE VA
22003
US

V. Phone/Fax

Practice location:
  • Phone: 703-658-0330
  • Fax: 703-658-3162
Mailing address:
  • Phone: 703-658-0330
  • Fax: 703-658-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007722
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: