Provider Demographics
NPI:1770373458
Name:SOAFER, KELLIE ELIZABETH (DMD)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:ELIZABETH
Last Name:SOAFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14245 CENTREVILLE SQUARE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-828-3375
Mailing Address - Fax:
Practice Address - Street 1:14245 CENTREVILLE SQUARE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-828-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014194261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice