Provider Demographics
NPI:1215189816
Name:MAHLER, BRIAN A (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:MAHLER
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 1:10550 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3133
Mailing Address - Country:US
Mailing Address - Phone:703-273-7846
Mailing Address - Fax:703-352-0897
Practice Address - Street 1:10550 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3133
Practice Address - Country:US
Practice Address - Phone:703-273-7846
Practice Address - Fax:703-352-0897
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA48941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA125750358OtherAMERICAN DENTAL ASSOCIATION ID NUMBER