Organization
KIM IERNA KITCHEN DDS, PC
Active
Other names
Old Town Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM IERNA KITCHEN DDS (OWNER/DENTIST)
(703) 836-7000
Entity
Organization
Contact information
Practice address
500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
(703) 836-7000
Mailing address
500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
(703) 836-7000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134350853
ASSOCIATE DENTIST
—
Enumeration date
11/05/2020
Last updated
11/05/2020
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