Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DEN1000506 | DC |
NPI | 1083899520 |
---|---|
Provider Name | Dr. Stephanie G Djeu |
First Address | Chantilly, VA 20151-4223 |
Second Address | Chantilly, VA 20151-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 05/04/2011 |