Provider Demographics
NPI:1154871713
Name:NORTHERN VIRGINIA DENTAL ARTS PC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA DENTAL ARTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-629-5847
Mailing Address - Street 1:400 CORPORATE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-4896
Mailing Address - Country:US
Mailing Address - Phone:703-291-5738
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4896
Practice Address - Country:US
Practice Address - Phone:703-291-5738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty