Provider Demographics
NPI:1205026283
Name:ZIVKOVIC, BRIGITTE WHITE (DMD)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:WHITE
Last Name:ZIVKOVIC
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 1:6101 CALICO POOL LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3704
Mailing Address - Country:US
Mailing Address - Phone:703-508-2188
Mailing Address - Fax:
Practice Address - Street 1:6214 OLD FRANCONIA RD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3400
Practice Address - Country:US
Practice Address - Phone:703-719-6158
Practice Address - Fax:202-244-9609
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10006521223G0001X
PADS0430151223G0001X
VA04014121871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice