Healthcare Provider Details

I. General information

NPI: 1679969653
Provider Name (Legal Business Name): ALYSSA HARTMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ALYSSA WERNER

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 11/09/2017
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 TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414811
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: