Provider Demographics
NPI:1871794099
Name:ARMENTROUT, NADIA AMTAL (DDS)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:AMTAL
Last Name:ARMENTROUT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41909 GALLBERRY TER
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5664
Mailing Address - Country:US
Mailing Address - Phone:413-559-9767
Mailing Address - Fax:
Practice Address - Street 1:100 PURCELLVILLE GATEWAY DR STE D
Practice Address - Street 2:DENTAL SMILES PURCELLVILLE
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3487
Practice Address - Country:US
Practice Address - Phone:540-338-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114701223G0001X
VT016-00022551223G0001X
MA223371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice