Healthcare Provider Details

I. General information

NPI: 1780023036
Provider Name (Legal Business Name): DRS. DELGADO & KUZMIK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 LEESBURG PIKE SUITE 720
VIENNA VA
22182-2639
US

IV. Provider business mailing address

8230 LEESBURG PIKE SUITE 720
VIENNA VA
22182-2639
US

V. Phone/Fax

Practice location:
  • Phone: 703-506-1414
  • Fax: 703-506-9488
Mailing address:
  • Phone: 703-506-1414
  • Fax: 703-506-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000013
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000014
License Number StateVA

VIII. Authorized Official

Name: DR. EDWARD DELGADO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 703-506-1414