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General NPI Number Information
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NPI Number | 1356638431
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Entity Type | Individual
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Provider Name | VITALIYA GENIEVA DDS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 99 CANAL CENTER PLAZA DENTAL BAR, STE 505
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City | ALEXANDRIA
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State | VA
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Zip | 22314
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Country | US
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Telephone | 703-214-7748
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Fax |
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Provider Business Mailing Address
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Address Line | 99 CANAL CENTER PLAZA STE 505
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City | ALEXANDRIA
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State | VA
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Zip | 22314
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Country | US
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Telephone | 703-214-7748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS038707
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 055648-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401414191
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License Number State | VA
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