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Organization
GD VA MOUNT VERNON PLLC
Active
Organization
GD VA MOUNT VERNON PLLC
Active
Other names
MT Vernon Center for Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
8101 HINSON FARM RD STE 114, ALEXANDRIA, VA 22306-3404
(703) 360-5881
Mailing address
8101 HINSON FARM RD STE 114, ALEXANDRIA, VA 22306-3404
(703) 360-5881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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