Provider Demographics
NPI:1295969434
Name:KRIEGER, ELLEN V (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:V
Last Name:KRIEGER
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 1:7448 OLD MAPLE SQ
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2817
Mailing Address - Country:US
Mailing Address - Phone:703-929-0998
Mailing Address - Fax:703-893-3970
Practice Address - Street 1:6707 OLD DOMINION DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4504
Practice Address - Country:US
Practice Address - Phone:703-673-6363
Practice Address - Fax:703-893-3970
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist