Provider Demographics
NPI:1770780900
Name:DIONISIO-MA, JANICE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:DIONISIO-MA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 SIR VICEROY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3713
Mailing Address - Country:US
Mailing Address - Phone:703-672-0664
Mailing Address - Fax:703-672-0636
Practice Address - Street 1:6831 SIR VICEROY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3713
Practice Address - Country:US
Practice Address - Phone:703-672-0664
Practice Address - Fax:703-672-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141191223G0001X
VA0401411946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice