Healthcare Provider Details

I. General information

NPI: 1982160149
Provider Name (Legal Business Name): THE VIRGINIA ENDODONTIC GROUP - LOUDOUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 SANDRIDGE WAY STE 270
LANSDOWNE VA
20176-3693
US

IV. Provider business mailing address

6831 SIR VICEROY DR STE 210
ALEXANDRIA VA
22315-3719
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TU-SON NGO
Title or Position: OWNER
Credential:
Phone: 703-922-9040