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Organization

MITNICK & HERBST, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. VALERIE KAMMAN (OFFICE MANAGER)
(703) 444-3710
Entity
Organization

Contact information

Practice address
21475 RIDGETOP CIR, 200, STERLING, VA 20166-6580
(703) 444-3710
(703) 444-8607
Mailing address
21475 RIDGETOP CIR, 200, STERLING, VA 20166-6580
(703) 444-3710
(703) 444-8607

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
6232
VA
1223P0221X
Pediatric Dentistry
0184
VA
1223P0221X
Pediatric Dentistry
Primary
5876
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0008375
VA
05
0012899
VA
Enumeration date
07/12/2011
Last updated
07/12/2011
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