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General NPI Number Information
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NPI Number | 1154692408
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Entity Type | Organization
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Legal Business Name | ADDAX DENTAL PLLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 546 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-4112
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Country | US
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Telephone | 703-777-5939
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Fax |
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Provider Business Mailing Address
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Address Line | 546 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-4112
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Country | US
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Telephone | 703-777-5939
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Fax |
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Authorized Official
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Title or Position | MANAGING CLINICAL DIRECTOR
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Name | DR. MICHAEL DOE
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Credential | DMD
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Telephone | 703-777-5939
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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 | 0401413091
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License Number State | VA
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