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General NPI Number Information
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NPI Number | 1497052237
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Entity Type | Organization
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Legal Business Name | 610 DENTAL, P.C.
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 315 GARRISONVILLE RD SUITE 105B
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City | STAFFORD
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State | VA
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Zip | 22554-1542
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Country | US
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Telephone | 540-288-9212
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Fax |
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Provider Business Mailing Address
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Address Line | 315 GARRISONVILLE RD SUITE 105B
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City | STAFFORD
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State | VA
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Zip | 22554-1542
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Country | US
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Telephone | 540-288-9212
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ETHEL M MILES
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Credential | DDS
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Telephone | 540-288-9212
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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 | 0401006823
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License Number State | VA
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