Provider Demographics
NPI:1720588973
Name:STEPHEN A MABRY DDS PLC
Entity Type:Organization
Organization Name:STEPHEN A MABRY DDS PLC
Other - Org Name:STEPHEN A MABRY DDS PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-527-3554
Mailing Address - Street 1:2800 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2174
Mailing Address - Country:US
Mailing Address - Phone:703-527-3554
Mailing Address - Fax:
Practice Address - Street 1:2800 10TH ST N
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2174
Practice Address - Country:US
Practice Address - Phone:703-527-3554
Practice Address - Fax:703-527-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401411464OtherLICENSE NUMBER