Healthcare Provider Details

I. General information

NPI: 1518086438
Provider Name (Legal Business Name): DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 BACKLICK RD # D
SPRINGFIELD VA
22151-3915
US

IV. Provider business mailing address

5417 BACKLICK RD # D
SPRINGFIELD VA
22151-3915
US

V. Phone/Fax

Practice location:
  • Phone: 703-750-9404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ADRIAN LOFTON
Title or Position: MANAGER
Credential:
Phone: 703-269-3150