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General NPI Number Information
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NPI Number | 1558855619
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Entity Type | Organization
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Legal Business Name | GREENHILL FAMILY DENTAL CARE LLC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 14535 JOHN MARSHALL HWY STE 209
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City | GAINESVILLE
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State | VA
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Zip | 20155-4025
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Country | US
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Telephone | 703-753-2252
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Fax | 703-753-2268
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Provider Business Mailing Address
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Address Line | 14535 JOHN MARSHALL HWY STE 209
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City | GAINESVILLE
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State | VA
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Zip | 20155-4025
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Country | US
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Telephone | 703-753-2252
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Fax | 703-753-2268
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Authorized Official
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Title or Position | DENTIST/MEMBER OWNER
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Name | KIMBERLEY OLSEN
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Credential | DMD
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Telephone | 703-753-2252
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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 | 0401410917
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License Number State | VA
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