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General NPI Number Information
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NPI Number | 1730527110
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Entity Type | Organization
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Legal Business Name | VILLAGE ORAL AND IMPLANT SURGERY
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 1503 DODONA TERRACE SW 105
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City | LEESBURG
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State | VA
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Zip | 20175
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Country | US
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Telephone | 855-373-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 DODONA TERRACE SW 105
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City | LEESBURG
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State | VA
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Zip | 20175
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Country | US
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Telephone | 855-373-7688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN CHANG
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Credential | DMD
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Telephone | 855-373-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401413779
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401413499
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License Number State | VA
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