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General NPI Number Information
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NPI Number | 1184440372
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Entity Type | Organization
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Legal Business Name | LOWCOST DENTAL PC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 4324 EVERGREEN LN STE C
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City | ANNANDALE
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State | VA
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Zip | 22003-3272
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Country | US
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Telephone | 703-956-0071
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Fax | 703-256-3066
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Provider Business Mailing Address
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Address Line | 4324 EVERGREEN LN STE C
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City | ANNANDALE
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State | VA
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Zip | 22003-3272
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Country | US
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Telephone | 703-956-0071
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Fax | 703-256-3066
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUNE JUNE PARK
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Credential | DMD
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Telephone | 703-956-0071
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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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