Provider Demographics
NPI:1417902800
Name:PANDAK, HILARY KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:KEITH
Last Name:PANDAK
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 1:11208 WAPLES MILL RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6077
Mailing Address - Country:US
Mailing Address - Phone:703-691-1511
Mailing Address - Fax:
Practice Address - Street 1:11208 WAPLES MILL RD
Practice Address - Street 2:SUITE #101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6077
Practice Address - Country:US
Practice Address - Phone:703-691-1511
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice