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General NPI Number Information
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NPI Number | 1326413683
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Entity Type | Organization
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Legal Business Name | GEORGE XENAKIS DDS, VA, PLLC
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 13890 BRADDOCK RD STE 209-210
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City | CENTREVILLE
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State | VA
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Zip | 20121-2435
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Country | US
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Telephone | 703-278-2387
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Fax | 703-278-2196
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Provider Business Mailing Address
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Address Line | 13890 BRADDOCK RD STE 209-210
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City | CENTREVILLE
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State | VA
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Zip | 20121-2435
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Country | US
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Telephone | 703-278-2387
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Fax | 703-278-2196
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE XENAKIS
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Credential | D.D.S
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Telephone | 212-643-0927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 401414641
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License Number State | VA
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