Provider Demographics
NPI:1043324072
Name:JERROLD H EPSTEIN DOS PC
Entity type:Organization
Organization Name:JERROLD H EPSTEIN DOS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:HART
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-922-5404
Mailing Address - Street 1:6200 A OLD FRANCONIA ROAD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3408
Mailing Address - Country:US
Mailing Address - Phone:703-922-5404
Mailing Address - Fax:703-922-5406
Practice Address - Street 1:6200 A OLD FRANCONIA ROAD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3408
Practice Address - Country:US
Practice Address - Phone:703-922-5404
Practice Address - Fax:703-922-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010064831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
782130OtherUNITED CONCORDIA INSURANC
AE1346902OtherFEDERAL DEA