Dental Professionals of Virginia, P.c.

NPI #1992103543 in Herndon, Virginia

Provider Information

NPI Number: 1992103543
Entity Type: Organization
Organization Name: Dental Professionals of Virginia, P.c.
Subpart: Yes (part of a larger organization)
Parent Organization: DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 15, 2014
Last Updated: Dec 15, 2014

Practice Location

Address: 1020 ELDEN ST
Address 2: SUITE 106
City: Herndon
State: Virginia
ZIP Code: 20170-3843
Phone: (703) 955-4221

Authorized Official

Name: KIM WILSON
Title: CRED. SUPERVISOR
Phone: (217) 540-5170

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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