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General NPI Number Information
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NPI Number | 1528806031
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Entity Type | Organization
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Legal Business Name | LORTON PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 8998 LORTON STATION BLVD STE E&F
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City | LORTON
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State | VA
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Zip | 22079-4789
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Country | US
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Telephone | 703-344-0590
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Fax |
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Provider Business Mailing Address
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Address Line | 14573 POTOMAC MILLS RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6808
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Country | US
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Telephone | 703-499-9779
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SASHA GROSS
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Credential |
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Telephone | 240-601-3932
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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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