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General NPI Number Information
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NPI Number | 1609291533
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Entity Type | Organization
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Legal Business Name | PARKER-GRAY PEDIATRIC DENTAL CARE, PC
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 03/01/2014
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Provider Practice Location Address
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Address Line | 224 N FAYETTE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2433
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Country | US
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Telephone | 703-519-7275
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Fax | 703-519-7276
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Provider Business Mailing Address
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Address Line | 224 N FAYETTE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2433
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Country | US
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Telephone | 703-519-7275
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Fax | 703-519-7276
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Authorized Official
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Title or Position | DDS/OWNER
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Name | DR. KESHA STEPHENSON
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Credential |
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Telephone | 301-651-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401413943
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License Number State | VA
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