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General NPI Number Information
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NPI Number | 1265627103
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Entity Type | Organization
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Legal Business Name | DOMINION CRAFTSMAN SERVICES,LLC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 5011 WARWICK HILLS CT
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City | HAYMARKET
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State | VA
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Zip | 20169-3185
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Country | US
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Telephone | 703-508-5976
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Fax | 571-261-2746
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Provider Business Mailing Address
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Address Line | 5011 WARWICK HILLS CT
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City | HAYMARKET
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State | VA
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Zip | 20169-3185
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Country | US
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Telephone | 703-508-5976
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Fax | 571-261-2746
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN JOSEPH ULLMAN
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Credential |
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Telephone | 703-508-5976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2705105044
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License Number State | VA
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