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General NPI Number Information
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NPI Number | 1164264578
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Entity Type | Organization
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Legal Business Name | THE VIRGINIA ENDODONTIC GROUP-GAINESVILLE PLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 19500 SANDRIDGE WAY STE 270
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City | LANSDOWNE
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State | VA
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Zip | 20176-3693
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Country | US
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Telephone | 703-257-7406
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Fax |
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Provider Business Mailing Address
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Address Line | 13575 HEATHCOTE BLVD STE 140
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City | GAINESVILLE
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State | VA
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Zip | 20155-6693
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Country | US
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Telephone | 703-795-9911
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN LEE
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Credential | DMD
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Telephone | 703-795-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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