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General NPI Number Information
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NPI Number | 1134818834
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Entity Type | Individual
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Provider Name | DYLAN MATHEW THOMAS
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Gender | Male
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 481 GARRISONVILLE RD STE 105
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City | STAFFORD
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State | VA
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Zip | 22554-1601
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Country | US
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Telephone | 540-659-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 42090 BARRYMOORE PL
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City | CHANTILLY
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State | VA
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Zip | 20152-6438
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Country | US
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Telephone | 443-986-2289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401418526
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License Number State | VA
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