Provider Demographics
NPI:1639544455
Name:GEREN, JAMES D (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:GEREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3404
Mailing Address - Country:US
Mailing Address - Phone:703-360-5881
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD STE 114
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3404
Practice Address - Country:US
Practice Address - Phone:703-360-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist