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General NPI Number Information
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NPI Number | 1619696754
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Entity Type | Organization
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Legal Business Name | TYSONS DENTAL SPA
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 8300 BOONE BLVD STE 140
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City | VIENNA
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State | VA
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Zip | 22182-2626
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Country | US
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Telephone | 703-714-7374
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Fax | 703-714-7376
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Provider Business Mailing Address
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Address Line | 8300 BOONE BLVD STE 140
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City | VIENNA
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State | VA
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Zip | 22182-2626
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Country | US
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Telephone | 703-714-7374
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Fax | 703-714-7376
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Authorized Official
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Title or Position | OWNER
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Name | DR. SYLVIE LAM
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Credential | DDS
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Telephone | 703-714-7374
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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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