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General NPI Number Information
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NPI Number | 1194194407
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Entity Type | Organization
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Legal Business Name | DR.ANA FRAGA
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 2011 S GLEBE RD
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City | ARLINGTON
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State | VA
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Zip | 22204-5308
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Country | US
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Telephone | 703-929-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 SOUTH GLEBE ROAD
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City | ARLINGTON
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State | VA
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Zip | 22204
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Country | US
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Telephone | 703-929-5023
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Fax |
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Authorized Official
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Title or Position | DENTIST, ORTHODONTISAT
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Name | DR. ANA MARIA FRAGA
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Credential | D.D.S., M.S.
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Telephone | 703-356-7585
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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 | 0401005878
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License Number State | VA
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