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General NPI Number Information
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NPI Number | 1992303242
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Entity Type | Organization
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Legal Business Name | ANDERSON DENTAL ASSOCIATES III, PLLC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 15609 WINGSPAN CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1103
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Country | US
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Telephone | 860-817-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 WASHINGTON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22201-1942
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Country | US
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Telephone | 703-243-1810
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Fax | 703-243-1874
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Authorized Official
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Title or Position | DENTIST
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Name | JOSHUA WILFREDO ANDERSON
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Credential |
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Telephone | 860-817-2787
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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 |
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License Number State |
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