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General NPI Number Information
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NPI Number | 1154531051
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Entity Type | Individual
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Provider Name | ANDY MA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5407 CASTLE BAR LN
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5520
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Country | US
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Telephone | 703-975-4038
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Fax | 703-971-5973
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Provider Business Mailing Address
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Address Line | 5407 CASTLE BAR LN
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5520
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Country | US
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Telephone | 703-975-4038
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Fax | 703-971-5974
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410721
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License Number State | VA
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