=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598058281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CNS DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2011
-----------------------------------------------------
Last Update Date | 05/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 S. GLEBE RD. #195
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-963-0996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3650 S GLEBE RD STE 195
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-963-0996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PRESIDENT
-----------------------------------------------------
Name | DR. CARA SCHANTZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 202-285-9406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 041411557
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------