Healthcare Provider Details

I. General information

NPI: 1942182563
Provider Name (Legal Business Name): ENDIE NAIA SUCKIEL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENDIE NAIA DAVIS RDH

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14573 POTOMAC MILLS RD
WOODBRIDGE VA
22192-6808
US

IV. Provider business mailing address

302 WIND RIDGE DR
STAFFORD VA
22554-4766
US

V. Phone/Fax

Practice location:
  • Phone: 703-499-9779
  • Fax:
Mailing address:
  • Phone: 443-500-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402207678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: