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General NPI Number Information
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NPI Number | 1871139519
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Entity Type | Organization
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Legal Business Name | GD VA PLLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 2553 CHAIN BRIDGE RD
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City | VIENNA
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State | VA
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Zip | 22181-5517
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Country | US
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Telephone | 703-938-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 2553 CHAIN BRIDGE ROAD ATTN: MICHELLE RYAN
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City | VIENNA
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State | VA
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Zip | 22181
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Country | US
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Telephone | 703-938-0212
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Fax | 703-938-2166
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Authorized Official
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Title or Position | INTEGRATION SPECIALIST
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Name | DAVID ROWE
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Credential |
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Telephone | 610-243-2018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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