Individual
DR. OLMEDO IVAN VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7501 LITTLE RIVER TPKE STE 105, ANNANDALE, VA 22003-2923
(703) 354-2878
(703) 354-2712
Mailing address
7501 LITTLE RIVER TPKE STE 105, ANNANDALE, VA 22003-2923
(703) 354-2878
(703) 354-2712
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007760
VA
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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