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General NPI Number Information
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NPI Number | 1700547932
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Entity Type | Organization
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Legal Business Name | PDC PEDIATRIC DENTAL CARE PLLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 9901 FAIRFAX BLVD
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City | FAIRFAX
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State | VA
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Zip | 22030-1740
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Country | US
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Telephone | 703-383-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 9901 FAIRFAX BLVD
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City | FAIRFAX
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State | VA
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Zip | 22030-1740
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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 | VP INSURANCE PLAN MANAGEMENT
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Name | MICHAEL COLE
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Credential |
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Telephone | 727-424-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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