Provider Demographics
NPI:1467111401
Name:CLARENDON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CLARENDON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-522-8894
Mailing Address - Street 1:1301 N HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5017
Mailing Address - Country:US
Mailing Address - Phone:703-522-8894
Mailing Address - Fax:
Practice Address - Street 1:1301 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5017
Practice Address - Country:US
Practice Address - Phone:703-522-8894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty