Healthcare Provider Details

I. General information

NPI: 1982926622
Provider Name (Legal Business Name): TODD STEPHEN ANDOCHICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N HIGHLAND ST SUITE 300-N
ARLINGTON VA
22201-2196
US

IV. Provider business mailing address

1050 N HIGHLAND ST SUITE 300-N
ARLINGTON VA
22201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 703-527-3888
  • Fax: 703-527-2038
Mailing address:
  • Phone: 703-527-3888
  • Fax: 703-527-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: