Provider Demographics
NPI:1689765745
Name:MAYBERRY, RODNEY S (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:S
Last Name:MAYBERRY
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 1:2946 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-3023
Mailing Address - Country:US
Mailing Address - Phone:703-281-2111
Mailing Address - Fax:
Practice Address - Street 1:2946 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE N
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3023
Practice Address - Country:US
Practice Address - Phone:703-281-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice