Provider Demographics
NPI:1538807987
Name:WIDMAN, ABIGAIL SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:SUSAN
Last Name:WIDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 N SAINT ASAPH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2320
Mailing Address - Country:US
Mailing Address - Phone:614-905-9608
Mailing Address - Fax:
Practice Address - Street 1:5212 LYNGATE CT STE B
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1631
Practice Address - Country:US
Practice Address - Phone:703-978-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014191921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice