Provider Demographics
NPI:1134301500
Name:MESTAS, ERIC
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MESTAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 FRANCONIA ROAD SUITE D
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-971-2788
Mailing Address - Fax:703-922-9427
Practice Address - Street 1:5115 FRANCONIA RD STE D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1903
Practice Address - Country:US
Practice Address - Phone:703-971-2788
Practice Address - Fax:703-922-9427
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA77961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice