Healthcare Provider Details

I. General information

NPI: 1326413683
Provider Name (Legal Business Name): GEORGE XENAKIS DDS, VA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13890 BRADDOCK RD STE 209-210
CENTREVILLE VA
20121-2435
US

IV. Provider business mailing address

13890 BRADDOCK RD STE 209-210
CENTREVILLE VA
20121-2435
US

V. Phone/Fax

Practice location:
  • Phone: 703-278-2387
  • Fax: 703-278-2196
Mailing address:
  • Phone: 703-278-2387
  • Fax: 703-278-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number401414641
License Number StateVA

VIII. Authorized Official

Name: DR. GEORGE XENAKIS
Title or Position: OWNER
Credential: D.D.S
Phone: 212-643-0927