Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401004623 | VA |
NPI | 1003079930 |
---|---|
Provider Name | Dr. Charles Daniel Dent |
First Address | Oakton, VA 22124-3011 |
Second Address | Oakton, VA 22124-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 10/07/2008 |