Provider Demographics
NPI:1013368398
Name:ANDERSON DENTAL ASSOCIATES II PLLC
Entity Type:Organization
Organization Name:ANDERSON DENTAL ASSOCIATES II PLLC
Other - Org Name:RENOVASMILES WOODBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-670-5414
Mailing Address - Street 1:14007 MINNIEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2310
Mailing Address - Country:US
Mailing Address - Phone:703-670-5414
Mailing Address - Fax:703-670-4545
Practice Address - Street 1:14007 MINNIEVILLE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2310
Practice Address - Country:US
Practice Address - Phone:703-670-5414
Practice Address - Fax:703-670-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty