MEDICARE: MONICA ALEJANDRA BALVIDARES DH

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	124Q00000X	Dental Hygienist	30536	FL

General Provider Information

NPI Number	:	1710783246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ALEJANDRA BALVIDARES DH

Provider Business Mailing Address
First Line	:	7775 ASTERELLA CT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-3133
Country	:	US
Telephone Number	:	571-231-0841
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 COLUMBIA PIKE STE A
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5867
Country	:	US
Telephone Number	:	703-671-5437
Fax Number	:

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

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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