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General NPI Number Information
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NPI Number | 1114892882
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Entity Type | Organization
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Legal Business Name | DENTISTS OF CENTREVILLE PLLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 5703 CENTRE SQUARE DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-1916
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Country | US
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Telephone | 703-968-7022
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Fax |
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Provider Business Mailing Address
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Address Line | 5703 CENTRE SQUARE DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-1916
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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 | MANAGER
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Name | JUDANY DELGADO
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Credential |
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Telephone | 571-383-1103
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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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