Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401004979 | VA |
NPI | 1679574966 |
---|---|
Provider Name | Dr. Douglas M Arendt |
First Address | Fairfax, VA 22038-1447 |
Second Address | Fairfax, VA 22030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 18/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
492012 | (02) | |
I31300 | (02) | DC |