Healthcare Provider Details

I. General information

NPI: 1942017058
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF ARLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE APT 123
ARLINGTON VA
22204-4453
US

IV. Provider business mailing address

2301 COLUMBIA PIKE APT 123
ARLINGTON VA
22204-4453
US

V. Phone/Fax

Practice location:
  • Phone: 703-634-9450
  • Fax: 703-962-3339
Mailing address:
  • Phone: 703-634-9450
  • Fax: 703-962-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: IFEANYI ALEX OKOYE
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 281-857-5514