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General NPI Number Information
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NPI Number | 1336537372
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Entity Type | Organization
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Legal Business Name | HAWA MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 46175 WESTLAKE DR STE 130
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5873
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Country | US
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Telephone | 703-204-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 46175 WESTLAKE DR STE 130
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5873
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Country | US
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Telephone | 703-204-1766
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GREG LAYTON
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Credential |
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Telephone | 703-204-1766
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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 | 0401410094
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License Number State | VA
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