MEDICARE: DR. PETER LEWIS DORF 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	122300000X	Dentist	019032231	IL
2	171000000X	Military Health Care Provider	01903321	IL
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401416731	VA

General Provider Information

NPI Number	:	1174178263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER LEWIS DORF DMD

Provider Business Mailing Address
First Line	:	9225 DOERR RD STE 1220
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 DOERR RD
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	922-512-2022
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	10/02/2024

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