MEDICARE: AK ENDODONTICS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QD0000X	Dental Clinic/Center
2	1223E0200X	Endodontics
3	1223P0700X	Prosthodontics
4	1223G0001X	General Practice Dentistry
5	122300000X	Dentist

General Provider Information

NPI Number	:	1093442766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AK ENDODONTICS

Provider Business Mailing Address
First Line	:	311 MAPLE AVE W STE J
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	571-669-4088
Fax Number	:	301-597-7757

Provider Business Practice Location Address
First Line	:	311 MAPLE AVE W STE J
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	301-377-8306
Fax Number	:

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	ANA KIM
Credential	:	DMD
Telephone Number	:	301-366-2237

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	06/02/2026

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Directions to “AK ENDODONTICS ” Practice Location

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