Provider Demographics
NPI:1437326006
Name:DR. RICARDO GAITAN
Entity Type:Organization
Organization Name:DR. RICARDO GAITAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:MOISES
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS/PC
Authorized Official - Phone:703-450-5302
Mailing Address - Street 1:21525 RIDGETOP CIR
Mailing Address - Street 2:SUITE #220
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6510
Mailing Address - Country:US
Mailing Address - Phone:703-450-5302
Mailing Address - Fax:703-450-5694
Practice Address - Street 1:21525 RIDGETOP CIR
Practice Address - Street 2:SUITE #220
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6510
Practice Address - Country:US
Practice Address - Phone:703-450-5302
Practice Address - Fax:703-450-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008771261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA203535828OtherTAX ID