Healthcare Provider Details

I. General information

NPI: 1356152839
Provider Name (Legal Business Name): ANDREA LOUISE WASHINGTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 TUSCANY CT
WOODBRIDGE VA
22192-5520
US

IV. Provider business mailing address

4452 TUSCANY CT
WOODBRIDGE VA
22192-5520
US

V. Phone/Fax

Practice location:
  • Phone: 703-565-7192
  • Fax:
Mailing address:
  • Phone: 703-565-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402205619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: