Provider Demographics
NPI:1679574966
Name:ARENDT, DOUGLAS M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:ARENDT
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:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1447
Mailing Address - Country:US
Mailing Address - Phone:703-281-5970
Mailing Address - Fax:
Practice Address - Street 1:10347 B DEMOCRACY LANE
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-281-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049791223P0106X
VA49D1041147291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCI31300Medicare UPIN
492012Medicare UPIN