Provider Demographics
NPI:1366262909
Name:EUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC
Entity type:Organization
Organization Name:EUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETSUBDENK
Authorized Official - Middle Name:
Authorized Official - Last Name:AJEBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-426-3256
Mailing Address - Street 1:4211 FAIRFAX CORNER AVE E STE 225
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4211 FAIRFAX CORNER AVE E STE 225
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8623
Practice Address - Country:US
Practice Address - Phone:703-278-2473
Practice Address - Fax:703-239-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty