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General NPI Number Information
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NPI Number | 1063113199
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Entity Type | Organization
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Legal Business Name | LEESBURG DENTAL GROUP PLLC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 19 CATOCTIN CIR NE
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City | LEESBURG
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State | VA
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Zip | 20176-3100
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Country | US
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Telephone | 703-737-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 OLD COURTHOUSE RD STE A
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City | VIENNA
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State | VA
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Zip | 22182-3872
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEITH KALLAS
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Credential | DDS
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Telephone | 703-622-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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