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General NPI Number Information
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NPI Number | 1871990077
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Entity Type | Organization
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Legal Business Name | TOTALLY DENTAL
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 3223 DUKE ST SUITE G
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4586
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Country | US
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Telephone | 703-212-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 DUKE ST SUITE G
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4586
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Country | US
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Telephone | 703-212-7070
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JOSIE KEAT
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Credential | DDS
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Telephone | 703-212-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401005912
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License Number State | VA
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