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General NPI Number Information
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NPI Number | 1396020848
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Entity Type | Organization
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Legal Business Name | DENTAL CENTER OF MERRIFIELD INC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 2841 HARTLAND RD SUITE 202
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City | FALLS CHURCH
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State | VA
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Zip | 22043-3500
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Country | US
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Telephone | 703-663-8859
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Fax | 703-663-8138
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Provider Business Mailing Address
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Address Line | 2841 HARTLAND RD. SUITE 202
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City | FALLS CHURCH
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State | VA
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Zip | 22043
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Country | US
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Telephone | 703-663-8859
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Fax | 703-663-8138
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH QIU
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Credential |
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Telephone | 703-798-3964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 401411116
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 401412557
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 401102428
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License Number State | VA
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