Healthcare Provider Details

I. General information

NPI: 1265578413
Provider Name (Legal Business Name): BLUHM, DORSCH AND VANDERVORT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44340 PREMIER PLZ SUITE 100
ASHBURN VA
20147-5025
US

IV. Provider business mailing address

44340 PREMIER PLZ SUITE 100
ASHBURN VA
20147-5073
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-8700
  • Fax: 703-729-5300
Mailing address:
  • Phone: 703-729-8700
  • Fax: 703-729-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0401007764
License Number StateVA

VIII. Authorized Official

Name: DR. ANDREW EDWARD BLUHM
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 703-729-8700