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General NPI Number Information
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NPI Number | 1710783246
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Entity Type | Individual
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Provider Name | MONICA ALEJANDRA BALVIDARES DH
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5500 COLUMBIA PIKE STE A
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City | ARLINGTON
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State | VA
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Zip | 22204-5867
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Country | US
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Telephone | 703-671-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 7775 ASTERELLA CT
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City | SPRINGFIELD
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State | VA
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Zip | 22152-3133
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Country | US
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Telephone | 571-231-0841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 30536
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License Number State | FL
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