Healthcare Provider Details

I. General information

NPI: 1699367870
Provider Name (Legal Business Name): DYNAMIC FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 LAFAYETTE BLVD FL 2
FREDERICKSBURG VA
22408-4274
US

IV. Provider business mailing address

9010 LORTON STATION BLVD STE 270
LORTON VA
22079-4798
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-6500
  • Fax: 540-834-0363
Mailing address:
  • Phone: 571-418-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DANNIELLE VONDERLINDEN
Title or Position: OWNER
Credential: DPM
Phone: 571-418-8670