Healthcare Provider Details

I. General information

NPI: 1750959417
Provider Name (Legal Business Name): CAMERON TAYLOR DAHLQUIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 LITTLE RIVER TPKE STE 101E
ANNANDALE VA
22003-2630
US

IV. Provider business mailing address

7611 LITTLE RIVER TPKE STE 101E
ANNANDALE VA
22003-2630
US

V. Phone/Fax

Practice location:
  • Phone: 703-650-0638
  • Fax:
Mailing address:
  • Phone: 703-650-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401419858
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: