=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023411212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAUDIO URQUIAGA DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2014
-----------------------------------------------------
Last Update Date | 10/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13948 LEE JACKSON MEMORIAL HWY
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-378-5010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13948 LEE JACKSON MEMORIAL HWY
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-378-5010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CHRIS BARBOSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-378-5010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401412420
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------