Healthcare Provider Details

I. General information

NPI: 1245222652
Provider Name (Legal Business Name): DYNQUEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 LEE HWY STE 100
FAIRFAX VA
22031-1519
US

IV. Provider business mailing address

8550 LEE HWY STE 100
FAIRFAX VA
22031-1519
US

V. Phone/Fax

Practice location:
  • Phone: 703-846-0002
  • Fax: 703-846-0014
Mailing address:
  • Phone: 703-846-0002
  • Fax: 703-846-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberB-000099607
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberB-000099607
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberB-000099607
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004356
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number9000
License Number StateVA

VIII. Authorized Official

Name: MR. HENRY MERE
Title or Position: PARTNER
Credential:
Phone: 703-846-0002