Provider Demographics
NPI:1306133400
Name:ARDILA GAITAN, CLAUDIA MARCELA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:MARCELA
Last Name:ARDILA GAITAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ARMY NAVY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2905
Mailing Address - Country:US
Mailing Address - Phone:703-535-5568
Mailing Address - Fax:
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:SUITE 305
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist