Provider Demographics
NPI:1003597436
Name:WOTFE, GIANANDREA RIBEIRO (DMD)
Entity Type:Individual
Prefix:
First Name:GIANANDREA
Middle Name:RIBEIRO
Last Name:WOTFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 RIVA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1616
Mailing Address - Country:US
Mailing Address - Phone:425-520-5237
Mailing Address - Fax:
Practice Address - Street 1:105 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3339
Practice Address - Country:US
Practice Address - Phone:703-533-7285
Practice Address - Fax:703-533-7287
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014183581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice