Provider Demographics
NPI:1740622406
Name:ROBERT C DOST DDS PLLC
Entity type:Organization
Organization Name:ROBERT C DOST DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-491-4040
Mailing Address - Street 1:1990 OLD BRIDGE RD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2383
Mailing Address - Country:US
Mailing Address - Phone:703-491-4040
Mailing Address - Fax:703-494-4859
Practice Address - Street 1:1990 OLD BRIDGE RD
Practice Address - Street 2:SUITE #301
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2383
Practice Address - Country:US
Practice Address - Phone:703-491-4040
Practice Address - Fax:703-494-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40100-58311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty