Individual
MATTHEW DOUKENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
10090 MAIN ST, FAIRFAX, VA 22031-3412
(703) 273-4500
Mailing address
10090 MAIN ST, FAIRFAX, VA 22031-3412
(703) 273-4500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401007657
VA
Other
Enumeration date
06/15/2009
Last updated
06/15/2009
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