| Alexandria Old Town Dental Pllc | |
|
1421 Prince St Ste 140 Alexandria VA 22314-2771 | |
| (703) 549-1331 | |
| (703) 549-0480 |
| Full Name | Alexandria Old Town Dental Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1421 Prince St Ste 140, Alexandria, Virginia |
| Authorized Official Name and Position | Eddie Seymour Longman (DENTIST/OWNER) |
| Authorized Official Contact | 7035491331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Alexandria Old Town Dental Pllc 1421 Prince St Ste 140 Alexandria VA 22314-2771 Ph: (703) 549-1331 | Alexandria Old Town Dental Pllc 1421 Prince St Ste 140 Alexandria VA 22314-2771 Ph: (703) 549-1331 |
| NPI Number | 1518465939 |
|---|---|
| Provider Enumeration Date | 01/31/2018 |
| Last Update Date | 09/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518465939 | NPI | - | NPPES |
| 541192045 | Other | VA | GENERAL DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401004117 (Virginia) | Primary |
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