Healthcare Provider Details

I. General information

NPI: 1336134048
Provider Name (Legal Business Name): SCOTT BRANIN DUDLEY DMD, MSED, FAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N FILLMORE STREET SUITE C
ARLINGTON VA
22201
US

IV. Provider business mailing address

1025 N FILLMORE STREET SUITE C
ARLINGTON VA
22201
US

V. Phone/Fax

Practice location:
  • Phone: 703-243-4500
  • Fax: 703-243-4100
Mailing address:
  • Phone: 703-243-4500
  • Fax: 703-243-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1000421
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22D102229700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7973
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401412031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: