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General NPI Number Information
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NPI Number | 1447433578
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Entity Type | Organization
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Legal Business Name | TEAM DENTAL AT RIVER OAKS
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 16689 RIVER RIDGE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-4630
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Country | US
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Telephone | 703-221-9759
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Fax | 703-221-2782
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Provider Business Mailing Address
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Address Line | 16689 RIVER RIDGE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-4630
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Country | US
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Telephone | 703-221-9759
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Fax | 703-221-2782
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL ENON KING
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Credential | D.D.S.
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Telephone | 703-221-9759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 8593
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License Number State | VA
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