Provider Demographics
NPI:1356638431
Name:GENIEVA, VITALIYA (DDS)
Entity type:Individual
Prefix:MRS
First Name:VITALIYA
Middle Name:
Last Name:GENIEVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VITALIYA
Other - Middle Name:
Other - Last Name:NECHYPORENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:99 CANAL CENTER PLAZA
Mailing Address - Street 2:STE 505
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:703-214-7748
Mailing Address - Fax:
Practice Address - Street 1:99 CANAL CENTER PLAZA DENTAL BAR,
Practice Address - Street 2:STE 505
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:703-214-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387071223G0001X
NY055648-11223G0001X
VA04014141911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice