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General NPI Number Information
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NPI Number | 1326203381
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF TYSONS CORNER
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 2038 MEADOW SPRINGS DR
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City | VIENNA
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State | VA
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Zip | 22182-3771
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Country | US
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Telephone | 703-349-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 8296 OLD COURTHOUSE RD STE A
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City | VIENNA
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State | VA
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Zip | 22182-3852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. JULIE LIN BAVEJA
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Credential | D.D.S
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Telephone | 703-349-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 401412085
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License Number State | VA
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