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General NPI Number Information
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NPI Number | 1689106726
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Entity Type | Organization
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Legal Business Name | GROVE DENTAL CLINIC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 04/08/2017
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Provider Practice Location Address
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Address Line | 8355B GREENSBORO DR
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City | MC LEAN
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State | VA
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Zip | 22102-3530
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Country | US
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Telephone | 703-866-8096
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Fax | 703-866-8097
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Provider Business Mailing Address
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Address Line | 8355B GREENSBORO DR
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City | MC LEAN
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State | VA
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Zip | 22102-3530
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Country | US
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Telephone | 703-866-8096
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Fax | 703-866-8097
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CYNTHIA ERIKA NAUPARI DE NUNEZ
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Credential |
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Telephone | 703-866-8096
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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 |
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License Number State | VA
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