Provider Demographics
NPI:1639405558
Name:ACKERMAN & ASSOCIATES OF ALEXANDRIA, DDS, LLC
Entity Type:Organization
Organization Name:ACKERMAN & ASSOCIATES OF ALEXANDRIA, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-931-0200
Mailing Address - Street 1:5055 SEMINARY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2034
Mailing Address - Country:US
Mailing Address - Phone:703-931-0200
Mailing Address - Fax:703-931-0209
Practice Address - Street 1:5055 SEMINARY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2034
Practice Address - Country:US
Practice Address - Phone:703-931-0200
Practice Address - Fax:703-931-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010040441223G0001X
VA04010077431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty