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General NPI Number Information
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NPI Number | 1871584110
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Entity Type | Organization
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Legal Business Name | CHARLES D, KIRKSEY, DDS, LLC
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 10611 JUDICIAL DR
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City | FAIRFAX
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State | VA
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Zip | 22030-5165
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Country | US
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Telephone | 703-385-0303
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Fax | 703-385-1445
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Provider Business Mailing Address
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Address Line | 10611 JUDICIAL DR
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City | FAIRFAX
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State | VA
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Zip | 22030-5165
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Country | US
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Telephone | 703-385-0303
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Fax | 703-385-1445
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ASHLEY K ROWLAND
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Credential |
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Telephone | 703-385-0303
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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 | 5454
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License Number State | VA
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