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General NPI Number Information
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NPI Number | 1578685939
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Entity Type | Organization
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Legal Business Name | MIGNONETTE LOBO INC
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6319 CASTLE PL SUITE 1A
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City | FALLS CHURCH
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State | VA
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Zip | 22044-1907
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Country | US
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Telephone | 703-536-4900
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Fax | 703-532-4988
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Provider Business Mailing Address
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Address Line | 6319 CASTLE PL SUITE 1A
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City | FALLS CHURCH
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State | VA
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Zip | 22044-1907
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Country | US
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Telephone | 703-536-4900
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Fax | 703-532-4988
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGNONETTE ESTHER LOBO
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Credential |
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Telephone | 703-536-4900
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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 | 0401410656
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License Number State | VA
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