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General NPI Number Information
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NPI Number | 1114661576
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Entity Type | Organization
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Legal Business Name | PRIME DENTAL CARE PLLC
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 12719 APOLLO DR
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City | DALE CITY
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State | VA
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Zip | 22193
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Country | US
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Telephone | 301-366-2682
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Fax |
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Provider Business Mailing Address
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Address Line | 14361 STONEWATER CT
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City | CENTREVILLE
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State | VA
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Zip | 20121-5731
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Country | US
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Telephone | 301-366-2682
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JASWINDER SINGH
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Credential | DDS
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Telephone | 301-366-2682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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