Healthcare Provider Details

I. General information

NPI: 1164911863
Provider Name (Legal Business Name): ARLINGTON DENTAL EXCELLENCE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 FAIRFAX DR STE 54
ARLINGTON VA
22203-1762
US

IV. Provider business mailing address

3801 FAIRFAX DR STE 54
ARLINGTON VA
22203-1762
US

V. Phone/Fax

Practice location:
  • Phone: 170-352-5015
  • Fax: 703-525-3241
Mailing address:
  • Phone: 170-352-5015
  • Fax: 703-525-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BAN BAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-525-0157