Healthcare Provider Details

I. General information

NPI: 1346492949
Provider Name (Legal Business Name): SOUTH RIDING FAMILY DENTISTRY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43063 PEACOCK MARKET PLZ SUITE 125
SOUTH RIDING VA
20152-4473
US

IV. Provider business mailing address

43063 PEACOCK MARKET PLZ SUITE 125
SOUTH RIDING VA
20152-4473
US

V. Phone/Fax

Practice location:
  • Phone: 703-327-0327
  • Fax:
Mailing address:
  • Phone: 703-327-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CINDY LOAYZA
Title or Position: PRACTICE MGR.
Credential:
Phone: 703-327-0327