MEDICARE: ALEXANDRIA DENTAL CARE, P.C.

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	1223G0001X	General Practice Dentistry	0401410604	VA

General Provider Information

NPI Number	:	1861410714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRIA DENTAL CARE, P.C.

Provider Business Mailing Address
First Line	:	1451 BELLE HAVEN RD
Second Line	:	#210
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1201
Country	:	US
Telephone Number	:	703-955-3960
Fax Number	:	703-842-8407

Provider Business Practice Location Address
First Line	:	1451 BELLE HAVEN RD
Second Line	:	#210
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1201
Country	:	US
Telephone Number	:	703-955-3960
Fax Number	:	703-842-8407

Authorized Official
Title or Position	:	DENTIST
Name	:	MS. NHIEN LU
Credential	:	D.D.S.
Telephone Number	:	703-955-3960

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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