Organization
SSD - STAFFORD PLLC
Active
Other names
Stafford Smile Design
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
12 PGA DR, SUITE 201, STAFFORD, VA 22554
(540) 720-2627
Mailing address
12 PGA DR, SUITE 201, STAFFORD, VA 22554
(540) 720-2627
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/24/2025
Last updated
02/24/2025
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