# KIDZ DENTAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336561315
- **Authorized official:** JEREMY HODGE (OWNER)
- **Authorized official phone:** (571) 921-1111

## Contact information

- **Practice address:** 13648 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-2005
- **Practice address phone:** (571) 921-1111
- **Mailing address:** 13648 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-2005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401413527 | VA | Yes |

## Other

- **Enumeration date:** 01/10/2014
- **Last updated:** 01/10/2014