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General NPI Number Information
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NPI Number | 1659765964
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE TMJ & SLEEP WELLNESS INC.
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 807 CAMERON ST.
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City | ALEXANDRIA
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State | VA
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Zip | 22314
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Country | US
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Telephone | 703-239-6475
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Fax |
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Provider Business Mailing Address
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Address Line | 807 CAMERON STREET
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City | ALEXANDRIA
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State | VA
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Zip | 22314
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Country | US
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Telephone | 703-239-6475
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAWRENCE DAVID SINGER
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Credential | DMD
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Telephone | 703-239-6475
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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 | 0401410067
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License Number State | VA
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