Healthcare Provider Details

I. General information

NPI: 1902731789
Provider Name (Legal Business Name): WOODBRIDGE ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 MARBLESTONE DR STE 105
WOODBRIDGE VA
22192-8334
US

IV. Provider business mailing address

12731 MARBLESTONE DR STE 105
WOODBRIDGE VA
22192-8334
US

V. Phone/Fax

Practice location:
  • Phone: 571-260-0012
  • Fax:
Mailing address:
  • Phone: 571-260-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAD HENDRICKS
Title or Position: CREDENTIALING
Credential:
Phone: 612-859-0444