Provider Demographics
NPI:1790051282
Name:DARY, PATRICIA MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIA
Last Name:DARY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12791 FAIR BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3850
Mailing Address - Country:US
Mailing Address - Phone:571-426-4579
Mailing Address - Fax:
Practice Address - Street 1:10721 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-865-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014145851223G0001X
NJ22DI025299001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice