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General NPI Number Information
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NPI Number | 1205407467
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Entity Type | Organization
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Legal Business Name | NOVA PERIO SPECIALISTS
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 21165 WHITFIELD PL STE 107
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City | STERLING
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State | VA
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Zip | 20165-7276
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Country | US
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Telephone | 703-444-4377
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Fax | 703-444-7383
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Provider Business Mailing Address
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Address Line | 21165 WHITFIELD PL STE 107
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City | STERLING
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State | VA
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Zip | 20165-7276
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Country | US
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Telephone | 703-444-4377
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Fax | 703-444-7383
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Authorized Official
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Title or Position | MANAGER
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Name | CRYSTAL SPARKS
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Credential |
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Telephone | 703-444-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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