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General NPI Number Information
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NPI Number | 1407364300
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Entity Type | Organization
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Legal Business Name | DERMUTOPIA
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Dates
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Enumeration Date | 01/14/2018
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 370 MAPLE AVE W STE V
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City | VIENNA
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State | VA
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Zip | 22180-5615
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Country | US
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Telephone | 703-229-2544
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Fax |
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Provider Business Mailing Address
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Address Line | 12411 MACAO CT
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City | OAK HILL
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State | VA
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Zip | 20171-2140
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Country | US
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Telephone | 703-229-3156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENDA DINTIMAN
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Credential | MD
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Telephone | 703-299-3156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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