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General NPI Number Information
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NPI Number | 1659643005
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Entity Type | Organization
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Legal Business Name | AM CUJAR DDS & ASSOCIATES S-CORP
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 104 ELDEN ST SUITE 10
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City | HERNDON
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State | VA
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Zip | 20170-4871
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Country | US
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Telephone | 703-889-5420
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Fax | 703-889-5419
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Provider Business Mailing Address
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Address Line | 104 ELDEN ST SUITE 10
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City | HERNDON
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State | VA
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Zip | 20170-4871
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Country | US
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Telephone | 703-889-5420
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Fax | 703-889-5419
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. CAMILO CUJAR
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Credential |
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Telephone | 703-889-5420
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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 | 0401411978
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License Number State | VA
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