=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124322169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID PAINO DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 11/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 MAPLE AVE W SUITE A
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22180-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-281-7104
-----------------------------------------------------
Fax | 703-281-2175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 MAPLE AVE W SUITE A
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22180-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-281-7104
-----------------------------------------------------
Fax | 703-281-2175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID PAINO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 703-281-7104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 401411121
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 05322
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------