Organization
GD VA GDA PLLC
Active
Other names
Galleria Dental Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
1600 TYSONS BLVD STE 120, MC LEAN, VA 22102-4882
(703) 527-1020
Mailing address
1600 TYSONS BLVD STE 120, MC LEAN, VA 22102-4882
(703) 448-1020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
03/17/2023
Last updated
07/05/2023
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