MEDICARE: MARY CATHERINE DVORAK DDS

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	0401006747	VA

General Provider Information

NPI Number	:	1982759387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CATHERINE DVORAK DDS

Provider Business Mailing Address
First Line	:	2010 OPITZ BLVD STE D
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3359
Country	:	US
Telephone Number	:	703-494-6690
Fax Number	:	703-494-9600

Provider Business Practice Location Address
First Line	:	2010 OPITZ BLVD STE D
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3359
Country	:	US
Telephone Number	:	703-494-6690
Fax Number	:	703-494-9600

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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