Provider Demographics
NPI:1174802623
Name:ABRIL, EDISON A (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EDISON
Middle Name:A
Last Name:ABRIL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 MOZART BRIGADE LN
Mailing Address - Street 2:APARTMENT Y
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3906
Mailing Address - Country:US
Mailing Address - Phone:703-870-5908
Mailing Address - Fax:
Practice Address - Street 1:4210 MOZART BRIGADE LN
Practice Address - Street 2:APARTMENT Y
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3906
Practice Address - Country:US
Practice Address - Phone:703-870-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics