Provider Demographics
NPI:1699367870
Name:DYNAMIC FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:DYNAMIC FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VONDERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:571-418-8670
Mailing Address - Street 1:9010 LORTON STATION BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4798
Mailing Address - Country:US
Mailing Address - Phone:571-418-8670
Mailing Address - Fax:
Practice Address - Street 1:4103 LAFAYETTE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4274
Practice Address - Country:US
Practice Address - Phone:540-898-6500
Practice Address - Fax:540-834-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty