Provider Demographics
NPI:1225367154
Name:NEIDERT, GENA RHEA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:RHEA
Last Name:NEIDERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-5339
Mailing Address - Country:US
Mailing Address - Phone:571-213-7540
Mailing Address - Fax:
Practice Address - Street 1:12701 MARBLESTONE DR STE 260
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8326
Practice Address - Country:US
Practice Address - Phone:703-670-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist