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General NPI Number Information
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NPI Number | 1568030161
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Entity Type | Organization
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Legal Business Name | IMPACT DENTAL CARE WOODBRIDGE, PLLC
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 2701 NEABSCO COMMON PLACE, UNIT 126
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone | 703-576-8700
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Fax | 703-576-8787
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Provider Business Mailing Address
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Address Line | 2701 NEABSCO COMMON PLACE, UNIT 126
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HARPREET KAUR
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Credential |
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Telephone | 703-952-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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