Provider Demographics
NPI:1710783246
Name:BALVIDARES, MONICA ALEJANDRA (DH)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ALEJANDRA
Last Name:BALVIDARES
Suffix:
Gender:
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 ASTERELLA CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3133
Mailing Address - Country:US
Mailing Address - Phone:571-231-0841
Mailing Address - Fax:
Practice Address - Street 1:5500 COLUMBIA PIKE STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5867
Practice Address - Country:US
Practice Address - Phone:703-671-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30536124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist