Provider Demographics
NPI:1740566868
Name:OLD TOWN DENTAL PARTNERS
Entity type:Organization
Organization Name:OLD TOWN DENTAL PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLASANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-683-6688
Mailing Address - Street 1:1500 KING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2730
Mailing Address - Country:US
Mailing Address - Phone:703-683-6688
Mailing Address - Fax:
Practice Address - Street 1:225 REINEKERS LN STE GR2
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2856
Practice Address - Country:US
Practice Address - Phone:703-548-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA108381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty