Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401414660 | VA |
NPI | 1053705517 |
---|---|
Provider Name | Dr. Melanie Ventocilla Jones |
First Address | Alexandria, VA 22304-1924 |
Second Address | Washington, DC 20059-1022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 23/03/2015 |