Provider Demographics
NPI:1336360072
Name:ACKERMAN, JEFFREY A (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 FIRESIDE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3712
Mailing Address - Country:US
Mailing Address - Phone:703-425-5969
Mailing Address - Fax:
Practice Address - Street 1:5502 FIRESIDE CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3712
Practice Address - Country:US
Practice Address - Phone:703-425-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAAA5831614OtherDEA