Provider Demographics
NPI:1346395084
Name:DOMINICK J. PISCIOTTA, D.D.S., LTD.
Entity Type:Organization
Organization Name:DOMINICK J. PISCIOTTA, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PISCIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-313-0404
Mailing Address - Street 1:6408 GROVEDALE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2596
Mailing Address - Country:US
Mailing Address - Phone:703-313-0404
Mailing Address - Fax:703-313-6870
Practice Address - Street 1:6408 GROVEDALE DR STE 100
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2596
Practice Address - Country:US
Practice Address - Phone:703-313-0404
Practice Address - Fax:703-313-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty