Provider Demographics
NPI:1598190407
Name:DKDC FALLS CHURCH PLLC
Entity Type:Organization
Organization Name:DKDC FALLS CHURCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-417-9840
Mailing Address - Street 1:5659 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5659 COLUMBIA PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2878
Practice Address - Country:US
Practice Address - Phone:703-417-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty