# VALDIVIASMILES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FamiDental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306628482
- **Authorized official:** DR. WALDO VALDIVIA (DENTIST)
- **Authorized official phone:** (703) 952-4003

## Contact information

- **Practice address:** 9554 OLD KEENE MILL RD STE C, BURKE, VA 22015-4287
- **Practice address phone:** (703) 952-4003
- **Practice address fax:** (571) 281-0001
- **Mailing address:** 9554 OLD KEENE MILL RD STE C, BURKE, VA 22015-4287
- **Mailing address phone:** (703) 952-4003
- **Mailing address fax:** (571) 281-0001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2023
- **Last updated:** 10/16/2023