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NPI Code Detail

MEDICARE: DENTISTS OF OLD TOWN ALEXANDRIA

MEDICARE: DENTISTS OF OLD TOWN ALEXANDRIA
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1780559450
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTISTS OF OLD TOWN ALEXANDRIA
Provider Business Mailing Address
First Line : 1438 DUKE ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-3403
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1438 DUKE ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-3403
Country : US
Telephone Number : 703-212-0602
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JUDANY DELAGDO
Credential :
Telephone Number : 571-383-1103
Provider Enumeration Date : 10/10/2025
Last Update Date : 10/10/2025

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Directions to “DENTISTS OF OLD TOWN ALEXANDRIA ” Practice Location

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