Provider Demographics
NPI:1003960253
Name:FUENTES, AGNES B (DDS)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:B
Last Name:FUENTES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ARMY NAVY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2905
Mailing Address - Country:US
Mailing Address - Phone:703-521-7802
Mailing Address - Fax:703-521-7803
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-521-7802
Practice Address - Fax:703-521-7803
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA72311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice