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General NPI Number Information
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NPI Number | 1154871713
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA DENTAL ARTS PC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 400 CORPORATE DR SUITE 200
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City | STAFFORD
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State | VA
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Zip | 22554-4896
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Country | US
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Telephone | 703-291-5738
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CORPORATE DR SUITE 200
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City | STAFFORD
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State | VA
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Zip | 22554-4896
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Country | US
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Telephone | 703-291-5738
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSEPH KERNER
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Credential |
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Telephone | 703-629-5847
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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 |
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License Number State |
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