Provider Demographics
NPI:1689892242
Name:IWAMOTO, CLAUDIO ENRIQUE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIO
Middle Name:ENRIQUE
Last Name:IWAMOTO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19490 SANDRIDGE WAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3465
Mailing Address - Country:US
Mailing Address - Phone:703-858-3838
Mailing Address - Fax:703-858-5338
Practice Address - Street 1:14055 VERONA LN
Practice Address - Street 2:APT#15210
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-6350
Practice Address - Country:US
Practice Address - Phone:410-599-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127011223P0300X
VA04014107681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics