Provider Demographics
NPI:1174530851
Name:METZDORF, DAVID W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:METZDORF
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-352-5222
Mailing Address - Fax:703-352-9506
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-352-5222
Practice Address - Fax:703-352-9506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA 8900122300000X
VA0401008900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0013874Medicaid
VA13874Medicaid