Healthcare Provider Details

I. General information

NPI: 1548564297
Provider Name (Legal Business Name): ARLINGTON ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 NORTHFAIRFAX DRIVE SUITE 160
ARLINGTON VA
22203-1695
US

IV. Provider business mailing address

4350 N. FAIRFAX DR. SUITE 160
ARLINGTON VA
22204-1695
US

V. Phone/Fax

Practice location:
  • Phone: 571-312-3762
  • Fax: 571-312-3592
Mailing address:
  • Phone: 571-312-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401412857
License Number StateVA

VIII. Authorized Official

Name: DR. TAWANA D. FEIMSTER
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 571-312-3762