# KIM IERNA KITCHEN DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Old Town Smiles
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477154516
- **Authorized official:** DR. KIM IERNA KITCHEN DDS (OWNER/DENTIST)
- **Authorized official phone:** (703) 836-7000

## Contact information

- **Practice address:** 500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
- **Practice address phone:** (703) 836-7000
- **Mailing address:** 500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
- **Mailing address phone:** (703) 836-7000

## Taxonomy

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

## Other

- **Enumeration date:** 11/05/2020
- **Last updated:** 11/05/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1134350853 | ASSOCIATE DENTIST | — |