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General NPI Number Information
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NPI Number | 1396301990
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Entity Type | Organization
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Legal Business Name | STONE RIDGE PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 24600 MILLSTREAM DR
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City | STONE RIDGE
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State | VA
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Zip | 20105-5685
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Country | US
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Telephone | 703-867-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 AVONLEA WAY
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City | CATHARPIN
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State | VA
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Zip | 20143-2417
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Country | US
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Telephone | 703-867-4331
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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. PATRICIA ARTEAGA WOOD
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Credential | DDS, MS
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Telephone | 703-867-4331
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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 |
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License Number State |
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