NPI 1679548010

Gene Allen Vandervort, DDSMD

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Ashburn, VA

Practice location

Address: 44340 Premier Plaza Suite 100, Ashburn, VA 20147-5074
Phone: (703) 729-8700
Fax: (703) 729-5300

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence 0101102662 (VA)

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Registry record

NPI: 1679548010
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Feb 2006
Record last updated: 9 Jul 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.