Provider Demographics
NPI:1598738338
Name:PELL, JAMES ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:PELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:101 S WHITING ST
Mailing Address - Street 2:# 106
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-751-7841
Mailing Address - Fax:703-751-7858
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:# 116
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-435-4414
Practice Address - Fax:703-435-2210
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010064141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
955986OtherUNITED CONCORDIA
K918OtherCAREFIRST BCBS
955986OtherUNITED CONCORDIA
T31172Medicare UPIN