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General NPI Number Information
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NPI Number | 1205048972
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Entity Type | Organization
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Legal Business Name | DENTAL ONE ASSOCIATES (WOODSON SQUARE), LTD
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 9661 MAIN ST SUITE C
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City | FAIRFAX
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State | VA
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Zip | 22031-3757
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Country | US
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Telephone | 703-425-3737
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Fax | 703-425-3762
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Provider Business Mailing Address
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Address Line | 9661 MAIN ST SUITE C
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City | FAIRFAX
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State | VA
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Zip | 22031-3757
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Country | US
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Telephone | 703-425-3737
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Fax | 703-425-3762
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MS. STEPHANIE GOMEZ
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Credential |
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Telephone | 305-274-2499
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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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