Provider Demographics
NPI:1285792614
Name:DELONG, FAITH VENTURA (DDS)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:VENTURA
Last Name:DELONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:ANGELICA
Other - Last Name:VENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1018 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1642
Mailing Address - Country:US
Mailing Address - Phone:703-237-4378
Mailing Address - Fax:
Practice Address - Street 1:1701 CLARENDON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2700
Practice Address - Country:US
Practice Address - Phone:703-528-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19371223G0001X
VA04014141571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty