Provider Demographics
NPI:1649698804
Name:PLEKAVICH, EDWARD J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:PLEKAVICH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E HOLLY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5405
Mailing Address - Country:US
Mailing Address - Phone:703-450-4010
Mailing Address - Fax:
Practice Address - Street 1:107 E HOLLY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5405
Practice Address - Country:US
Practice Address - Phone:703-450-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics