=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093184970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIGMEY L. DORJEE, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2015
-----------------------------------------------------
Last Update Date | 09/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6011 WILSON BLVD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22205-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-474-7968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6011 WILSON BLVD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22205-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | DR. JIGMEY LHAZE DORJEE
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 703-474-7968
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 0401413673
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------