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General NPI Number Information
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NPI Number | 1609591981
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Entity Type | Organization
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Legal Business Name | LITTLE DENTAL STUDIO, P.C.
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 6303 LITTLE RIVER TPKE STE 345
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City | ALEXANDRIA
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State | VA
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Zip | 22312-5101
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Country | US
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Telephone | 703-495-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 6303 LITTLE RIVER TPKE STE 345
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City | ALEXANDRIA
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State | VA
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Zip | 22312-5101
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Country | US
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Telephone | 703-942-8404
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. ANGELA AUSTIN
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Credential | DMD
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Telephone | 703-495-3565
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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 |
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License Number State |
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