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Organization
GD VA SOUTH RIDING PLLC
Active
Organization
GD VA SOUTH RIDING PLLC
Active
Other names
South Riding Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
25055 RIDING PLZ STE 250, SOUTH RIDING, VA 20152-5921
(703) 327-7705
Mailing address
25055 RIDING PLZ STE 250, SOUTH RIDING, VA 20152-5921
(703) 327-7705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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