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General NPI Number Information
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NPI Number | 1578934196
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Entity Type | Organization
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Legal Business Name | GROVE DENTAL CLINIC, P.C.
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 8270 GREENSBORO DR SUITE NUMBER 101
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City | MC LEAN
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State | VA
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Zip | 22102-3800
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Country | US
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Telephone | 703-578-8888
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Fax | 866-229-6889
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Provider Business Mailing Address
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Address Line | 8270 GREENSBORO DR SUITE NUMBER 101
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City | MC LEAN
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State | VA
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Zip | 22102-3800
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Country | US
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Telephone | 703-578-8888
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Fax | 866-229-6889
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Authorized Official
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Title or Position | CEO
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Name | DR. MAQSOOD A CHAUDHRY
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Credential | DDS
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Telephone | 703-578-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401414938
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401414676
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007713
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License Number State | VA
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