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Organization
GD VA GDA PLLC
Active
Organization
GD VA GDA PLLC
Active
Other names
Galleria Dental Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
1600 TYSONS BLVD STE 120, MC LEAN, VA 22102-4882
(703) 527-1020
Mailing address
1600 TYSONS BLVD STE 120, MC LEAN, VA 22102-4882
(703) 448-1020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
03/17/2023
Last updated
07/05/2023
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