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General NPI Number Information
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NPI Number | 1437326006
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Entity Type | Organization
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Legal Business Name | DR. RICARDO GAITAN
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 21525 RIDGETOP CIR SUITE #220
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City | STERLING
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State | VA
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Zip | 20166-6510
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Country | US
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Telephone | 703-450-5302
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Fax | 703-450-5694
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Provider Business Mailing Address
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Address Line | 21525 RIDGETOP CIR SUITE #220
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City | STERLING
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State | VA
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Zip | 20166-6510
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Country | US
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Telephone | 703-450-5302
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Fax | 703-450-5694
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Authorized Official
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Title or Position | DENTAL
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Name | DR. RICARDO MOISES GAITAN
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Credential | DDS/PC
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Telephone | 703-450-5302
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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 | 0401008771
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License Number State | VA
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