# GD VA MOUNT VERNON PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MT Vernon Center for Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659091007
- **Authorized official:** CHAD HENDRICKS (CREDENTIALING)
- **Authorized official phone:** (612) 859-0444

## Contact information

- **Practice address:** 8101 HINSON FARM RD STE 114, ALEXANDRIA, VA 22306-3404
- **Practice address phone:** (703) 360-5881
- **Mailing address:** 8101 HINSON FARM RD STE 114, ALEXANDRIA, VA 22306-3404
- **Mailing address phone:** (703) 360-5881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |

## Other

- **Enumeration date:** 08/29/2022
- **Last updated:** 08/29/2022