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Organization
GD VA CDA PLLC
Active
Organization
GD VA CDA PLLC
Active
Other names
Center For Dental Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
5284 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 379-6400
Mailing address
5284 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 379-6400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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