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General NPI Number Information
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NPI Number | 1528222171
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Entity Type | Organization
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Legal Business Name | LEESBURG DENTAL P C
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 602 S KING ST SUITE 302
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City | LEESBURG
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State | VA
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Zip | 20175-3919
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Country | US
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Telephone | 703-777-2442
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Fax | 703-777-1510
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Provider Business Mailing Address
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Address Line | 602 S KING ST SUITE 302
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City | LEESBURG
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State | VA
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Zip | 20175-3919
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Country | US
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Telephone | 703-777-2442
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Fax | 703-777-1510
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DAHANA NARANJO
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Credential |
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Telephone | 703-777-2442
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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 | 0401410996
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License Number State | VA
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