Provider Demographics
NPI:1407969280
Name:TOMASELLI, PHILIP JOHN JR (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:TOMASELLI
Suffix:JR
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 1:5631 BURKE CENTRE PARKWAY SUITE N
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-425-4225
Mailing Address - Fax:703-425-7444
Practice Address - Street 1:5631 BURKE CENTRE PARKWAY SUITE N
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-4225
Practice Address - Fax:703-425-7444
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist