Provider Demographics
NPI:1437334794
Name:DWIVEDI, ANIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2664
Mailing Address - Country:US
Mailing Address - Phone:703-734-1080
Mailing Address - Fax:
Practice Address - Street 1:2071 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 410
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2664
Practice Address - Country:US
Practice Address - Phone:703-734-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010077071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice