=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851477848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMTHA BROTHERTON D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 12/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 HOLMES RUN PKWY SUITE C-5
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-212-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 HOLMES RUN PKWY SUITE C-5
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-212-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401410499
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------