Provider Demographics
NPI:1326413683
Name:GEORGE XENAKIS DDS, VA, PLLC
Entity Type:Organization
Organization Name:GEORGE XENAKIS DDS, VA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-643-0927
Mailing Address - Street 1:13890 BRADDOCK RD STE 209-210
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2435
Mailing Address - Country:US
Mailing Address - Phone:703-278-2387
Mailing Address - Fax:703-278-2196
Practice Address - Street 1:13890 BRADDOCK RD STE 209-210
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-278-2387
Practice Address - Fax:703-278-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401414641261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental