Healthcare Provider Details

I. General information

NPI: 1902477482
Provider Name (Legal Business Name): JB DENTAL ASSOCIATES AND TMD SLEEP CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR STE 310
STERLING VA
20165-5871
US

IV. Provider business mailing address

46161 WESTLAKE DR STE 310
STERLING VA
20165-5871
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-4188
  • Fax: 703-444-4309
Mailing address:
  • Phone: 703-444-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYCE H BAHNG
Title or Position: PRESIDENT
Credential: DMD
Phone: 703-444-4188