Provider Demographics
NPI:1407298706
Name:VIJ, VIVEK (DDS)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:VIJ
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 1:6015 LEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1917
Mailing Address - Country:US
Mailing Address - Phone:703-313-7885
Mailing Address - Fax:
Practice Address - Street 1:5765-M BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2264
Practice Address - Country:US
Practice Address - Phone:703-459-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001297122300000X
VA04014141001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist