Provider Demographics
NPI:1285021642
Name:CHIU, ALICE (DMD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CHIU
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 1:13628 LAVENDER MIST LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2610
Mailing Address - Country:US
Mailing Address - Phone:609-457-2679
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR
Practice Address - Street 2:SUITE 206A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4401
Practice Address - Country:US
Practice Address - Phone:703-771-3389
Practice Address - Fax:703-771-8242
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014144911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice