Individual
JUDITH R. COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
6116 ROLLING RD, SUITE 316, SPRINGFIELD, VA 22152-1521
(703) 451-8332
(703) 451-4661
Mailing address
6116 ROLLING RD, SUITE 316, SPRINGFIELD, VA 22152-1521
(703) 451-8332
(703) 451-4661
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7365
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
792905
UNITED CONCORDIA GROUP#
VI
Enumeration date
10/16/2006
Last updated
07/08/2007
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