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General NPI Number Information
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NPI Number | 1225200074
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Entity Type | Organization
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Legal Business Name | LENK FAMILY ORTHODONTICS, INC.
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 228 COMMONS PARKWAY
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City | DALEVILLE
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State | VA
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Zip | 24083
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Country | US
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Telephone | 540-966-3990
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 307
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City | DALEVILLE
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State | VA
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Zip | 24083
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Country | US
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Telephone | 540-966-3990
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. MISTY DAWN LENK
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Credential | DDS, MS
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Telephone | 540-966-3990
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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 | 0401411617
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License Number State | VA
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