| Alexandria Oral Surgery, Pc | |
|
4660 Kenmore Ave Suite 204 Alexandria VA 22304-1313 | |
| (703) 370-3012 | |
| (703) 370-6005 |
| Full Name | Alexandria Oral Surgery, Pc |
|---|---|
| Speciality | Dentist |
| Location | 4660 Kenmore Ave, Alexandria, Virginia |
| Authorized Official Name and Position | Jeffrey Rothman (PRESIDENT/OWNER) |
| Authorized Official Contact | 7033703012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alexandria Oral Surgery, Pc 4660 Kenmore Ave Suite 204 Alexandria VA 22304-1313 Ph: (703) 370-3012 | Alexandria Oral Surgery, Pc 4660 Kenmore Ave Suite 204 Alexandria VA 22304-1313 Ph: (703) 370-3012 |
| NPI Number | 1770707572 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 04/24/2014 |
| Medicare PECOS PAC ID | 2668407669 |
|---|---|
| Medicare Enrollment ID | O20050928001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770707572 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 05390 (Virginia) | Primary |
| Provider Name | Jeffrey R Rothman |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1366482796 PECOS PAC ID: 5193750107 Enrollment ID: I20120329000641 |
| Provider Name | Vincent Nguyen-cao |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134667827 PECOS PAC ID: 7214331990 Enrollment ID: I20210803000217 |
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