Healthcare Provider Details

I. General information

NPI: 1679284467
Provider Name (Legal Business Name): NORTHERN VIRGINIA ENDODONTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 FAIR RIDGE DR STE 300
FAIRFAX VA
22033-2907
US

IV. Provider business mailing address

949 1ST ST SE APT 1154
WASHINGTON DC
20003-4768
US

V. Phone/Fax

Practice location:
  • Phone: 571-446-3555
  • Fax: 571-446-3555
Mailing address:
  • Phone: 703-629-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW VO
Title or Position: MANAGER
Credential: DDS
Phone: 571-446-3555