Provider Demographics
NPI:1477576098
Name:PACE, WARREN JOSEPH JR (DDS)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:JOSEPH
Last Name:PACE
Suffix:JR
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 1:110 PLEASANT STREET. N.W.
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-938-6800
Mailing Address - Fax:703-938-3164
Practice Address - Street 1:110 PLEASANT STREET NW
Practice Address - Street 2:SUITE A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-938-6800
Practice Address - Fax:703-938-3164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60320OtherUNITED CONCORDIA