MEDICARE: AMERICAN URGENT DENTAL ALEXANDRIA VA PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336077841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN URGENT DENTAL ALEXANDRIA VA PLLC

Provider Business Mailing Address
First Line	:	2616 SHERWOOD HALL LN STE 403
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-214-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 SHERWOOD HALL LN STE 403
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-214-9143
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	ERIN PRESGRAVES
Credential	:	PRESGRAVES
Telephone Number	:	301-524-4543

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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