Provider Demographics
NPI:1134849441
Name:ZHAO, XIN (PREVENTIVE DENTAL)
Entity type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:PREVENTIVE DENTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARPENTER RD BLDG 525
Mailing Address - Street 2:
Mailing Address - City:FORT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 CARPENTER RD BLDG 525
Practice Address - Street 2:
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:804-637-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherPREVENTIVE DENTAL HYGIENIST