MEDICARE: DR. GINA GENEVIA ASKANDER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401416658	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0401416658	OTHER	VA	VIRGINIA DENTAL LICENSE

General Provider Information

NPI Number	:	1093367310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA GENEVIA ASKANDER DMD

Provider Business Mailing Address
First Line	:	6605 SKY BLUE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-5065
Country	:	US
Telephone Number	:	303-501-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 OLD LEE HWY STE 200A
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4376
Country	:	US
Telephone Number	:	703-705-9035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	01/21/2020

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