Provider Demographics
NPI:1922428101
Name:IVERSON, AARON JAMES (DDS)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JAMES
Last Name:IVERSON
Suffix:
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 1:3016 S CHASE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8732
Mailing Address - Country:US
Mailing Address - Phone:940-206-1503
Mailing Address - Fax:
Practice Address - Street 1:6912 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4806
Practice Address - Country:US
Practice Address - Phone:757-898-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415112122300000X, 1223G0001X
UT9294464-9922122300000X
SDD1054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice