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General NPI Number Information
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NPI Number | 1669802591
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Entity Type | Organization
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Legal Business Name | J CHRISTOPHER DURR LLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 4216 EVERGREEN LN SUITE 113
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City | ANNANDALE
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State | VA
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Zip | 22003-3243
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Country | US
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Telephone | 703-941-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 4216 EVERGREEN LN SUITE 113
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City | ANNANDALE
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State | VA
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Zip | 22003-3243
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Country | US
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Telephone | 703-941-7020
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Fax |
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Authorized Official
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Title or Position | MEMBER AND MANAGER
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Name | DR. JOHN CHRISTOPHER DURR JR.
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Credential | DDS JD
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Telephone | 703-941-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5391
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License Number State | VA
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