# KIDS & FAMILY DENTAL, P.C.

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

## Provider details

- **NPI number:** 1689933582
- **Authorized official:** JEREMY HODGE D.M.D. (OWNER)
- **Authorized official phone:** (571) 921-1111

## Contact information

- **Practice address:** 9012 MATHIS AVE, MANASSAS, VA 20110-5218
- **Practice address phone:** (571) 921-1111
- **Mailing address:** 9012 MATHIS AVE, MANASSAS, VA 20110-5218
- **Mailing address phone:** (571) 921-1111

## Taxonomy

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

## Other

- **Enumeration date:** 05/11/2012
- **Last updated:** 05/11/2012