Healthcare Provider Details

I. General information

NPI: 1558887224
Provider Name (Legal Business Name): B&R ENDODONTIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8987 HERSAND DR
BURKE VA
22015-1604
US

IV. Provider business mailing address

3833 FAIRFAX DR STE 440
ARLINGTON VA
22203-1773
US

V. Phone/Fax

Practice location:
  • Phone: 703-528-8382
  • Fax:
Mailing address:
  • Phone: 703-528-8382
  • Fax: 703-469-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A CHERON
Title or Position: MANAGING PARTNER
Credential: DMD
Phone: 703-528-8382