Provider Demographics
NPI:1619215670
Name:NALLS, BRIAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:NALLS
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 1:8150 LEESBURG PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:703-288-3299
Mailing Address - Fax:703-288-3297
Practice Address - Street 1:8150 LEESBURG PIKE STE 200
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2714
Practice Address - Country:US
Practice Address - Phone:703-288-3299
Practice Address - Fax:703-288-3297
Is Sole Proprietor?:No
Enumeration Date:2013-01-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014152051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics