Provider Demographics
NPI:1104849801
Name:TWIGG, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TWIGG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 ROLLING RD
Mailing Address - Street 2:XXXXXXXXXXXXXX
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2307
Mailing Address - Country:US
Mailing Address - Phone:703-569-6770
Mailing Address - Fax:703-569-9541
Practice Address - Street 1:6220 ROLLING RD
Practice Address - Street 2:XXXXXXXXXXXXXX
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2307
Practice Address - Country:US
Practice Address - Phone:703-569-6770
Practice Address - Fax:703-569-9541
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice