Provider Demographics
NPI:1851477848
Name:BROTHERTON, SAMTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMTHA
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 HOLMES RUN PKWY
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2863
Mailing Address - Country:US
Mailing Address - Phone:703-212-2001
Mailing Address - Fax:
Practice Address - Street 1:5500 HOLMES RUN PKWY
Practice Address - Street 2:SUITE C-5
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2863
Practice Address - Country:US
Practice Address - Phone:703-212-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice