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General NPI Number Information
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NPI Number | 1053604512
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Entity Type | Organization
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Legal Business Name | CARLOS ALAN HERESI, DDS, PC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 2501 FALL HILL AVE SUITE A
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3345
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Country | US
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Telephone | 540-371-6929
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 FALL HILL AVE SUITE A
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3345
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Country | US
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Telephone | 540-371-6929
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CARLOS ALAN HERESI
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Credential | DDS
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Telephone | 540-371-6929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412533
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License Number State | VA
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