Organization
GD VA CDA PLLC
Active
Other names
Center For Dental Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
5284 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 379-6400
Mailing address
5284 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 379-6400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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