Provider Demographics
NPI:1790228724
Name:MACRI, KAYLA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:C
Last Name:MACRI
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 1:2010 OPITZ BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3359
Mailing Address - Country:US
Mailing Address - Phone:703-494-6690
Mailing Address - Fax:703-494-9600
Practice Address - Street 1:2010 OPITZ BLVD STE D
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3359
Practice Address - Country:US
Practice Address - Phone:703-494-6690
Practice Address - Fax:703-494-9600
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist