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General NPI Number Information
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NPI Number | 1669878997
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Entity Type | Organization
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Legal Business Name | POTOMAC ORTHODONTICS PLLC
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 2200 OPITZ BLVD SUITE 370
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3321
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Country | US
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Telephone | 703-494-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 OPITZ BLVD SUITE 370
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ALICIA HUTCHISON
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Credential | D.D.S
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Telephone | 703-494-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401413821
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License Number State | VA
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