Gd Va Gda Pllc

NPI #1699477463 in Mc Lean, Virginia

Provider Information

NPI Number: 1699477463
Entity Type: Organization
Organization Name: Gd Va Gda Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 17, 2023
Last Updated: Jul 5, 2023

Practice Location

Address: 1600 TYSONS BLVD STE 120
City: Mc Lean
State: Virginia
ZIP Code: 22102-4882
Phone: (703) 527-1020

Authorized Official

Name: CHAD HENDRICKS
Title: CREDENTIALING
Phone: (612) 859-0444

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X
Dentist - General Practice — General Practice	1223G0001X	Primary

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