Provider Demographics
NPI:1770017626
Name:AARON J IVERSON DDS, PLLC
Entity Type:Organization
Organization Name:AARON J IVERSON DDS, PLLC
Other - Org Name:IVERSON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-206-1503
Mailing Address - Street 1:3016 S CHASE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8732
Mailing Address - Country:US
Mailing Address - Phone:940-206-1503
Mailing Address - Fax:
Practice Address - Street 1:6632 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4801
Practice Address - Country:US
Practice Address - Phone:940-206-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty