=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184069247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST IMPRESSION DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2013
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43810 CENTRAL STATION DR STE 100
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-7210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-465-2114
-----------------------------------------------------
Fax | 571-223-0015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43810 CENTRAL STATION DR STE 100
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-7210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-465-2114
-----------------------------------------------------
Fax | 571-223-0015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. CARTER REEVES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 703-473-7002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401412858
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------