MEDICARE: VIRGINIA DENTAL SOLUTIONS OF RESTON 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	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1568324184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA DENTAL SOLUTIONS OF RESTON PLLC

Provider Business Mailing Address
First Line	:	1890 PRESTON WHITE DR STE 200
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5430
Country	:	US
Telephone Number	:	703-437-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 PRESTON WHITE DR STE 200
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5430
Country	:	US
Telephone Number	:	703-437-8811
Fax Number	:

Authorized Official
Title or Position	:	RCM DIRECTOR
Name	:	KIM DAVIS
Credential	:
Telephone Number	:	703-568-5773

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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