Provider Demographics
NPI:1336379007
Name:SAMTHA BROTHERTON, DDS., PC
Entity Type:Organization
Organization Name:SAMTHA BROTHERTON, DDS., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-212-2001
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410499261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental