Provider Demographics
NPI:1679284467
Name:NORTHERN VIRGINIA ENDODONTIC SOLUTIONS
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA ENDODONTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-446-3555
Mailing Address - Street 1:949 1ST ST SE APT 1154
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4768
Mailing Address - Country:US
Mailing Address - Phone:703-629-5097
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2907
Practice Address - Country:US
Practice Address - Phone:571-446-3555
Practice Address - Fax:571-446-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty