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General NPI Number Information
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NPI Number | 1538351838
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Entity Type | Organization
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Legal Business Name | WOODBRIDGE FAMILY & COSMETIC DENTISTRY PLLC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 4421 DALE BLVD STE 202
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2550
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Country | US
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Telephone | 703-680-2070
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Fax | 703-680-7722
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Provider Business Mailing Address
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Address Line | 4421 DALE BLVD STE 202
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2550
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Country | US
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Telephone | 703-680-2070
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Fax | 703-680-7722
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHERYL LOBO
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Credential | D.D.S.
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Telephone | 703-680-2070
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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 |
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License Number State |
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