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General NPI Number Information
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NPI Number | 1023555760
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA PERIODONTICS, PLLC.
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 103 W BROAD ST STE. 601
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4235
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Country | US
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Telephone | 703-534-1766
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Fax | 703-534-1976
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Provider Business Mailing Address
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Address Line | 103 W BROAD ST STE. 601
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4235
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Country | US
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Telephone | 703-534-1766
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Fax | 703-534-1976
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANCISCO TOMAS CARLOS
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Credential | D.M.D., M.S.D., P.C.
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Telephone | 703-534-1766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 887
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License Number State | VA
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