Provider Demographics
NPI:1700877248
Name:SKORDALAKIS, EMMANUEL GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:GEORGE
Last Name:SKORDALAKIS
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 1:46950 JENNINGS FARM DR STE 160
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-8679
Mailing Address - Country:US
Mailing Address - Phone:703-421-3000
Mailing Address - Fax:703-230-2959
Practice Address - Street 1:46950 JENNINGS FARM DR
Practice Address - Street 2:SUITE 160
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-8679
Practice Address - Country:US
Practice Address - Phone:703-421-3000
Practice Address - Fax:703-433-9514
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist