Individual
DR. HOLLIE BLEVINS STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
120 BEULAH RD NE, VIENNA, VA 22180-4745
(703) 938-2000
Mailing address
120 BEULAH RD NE, VIENNA, VA 22180-4745
(703) 938-2000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007703
VA
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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