Healthcare Provider Details

I. General information

NPI: 1063861672
Provider Name (Legal Business Name): GENTLE CARE DENTISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N STUART STREET SUITE 101
ARLINGTON VA
22203
US

IV. Provider business mailing address

901 N STUART STREET SUITE 101
ARLINGTON VA
22203
US

V. Phone/Fax

Practice location:
  • Phone: 703-822-5583
  • Fax:
Mailing address:
  • Phone: 703-822-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. KEVIN SCOTTI
Title or Position: OWNER
Credential:
Phone: 703-822-5583