Provider Demographics
NPI:1851484935
Name:PRINCE WILLIAM HEALTH DISTRICT DENTAL
Entity Type:Organization
Organization Name:PRINCE WILLIAM HEALTH DISTRICT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:703-792-7300
Mailing Address - Street 1:13792 SMOKETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-792-7300
Mailing Address - Fax:703-792-7311
Practice Address - Street 1:13792 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-792-7300
Practice Address - Fax:703-792-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9177545Medicaid