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General NPI Number Information
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NPI Number | 1770362295
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Entity Type | Organization
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Legal Business Name | TYSONS CORNER ENDODONTICS
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 8150 LEESBURG PIKE STE 502
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City | VIENNA
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State | VA
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Zip | 22182-2714
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Country | US
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Telephone | 703-288-3299
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Fax | 703-288-3297
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Provider Business Mailing Address
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Address Line | 8150 LEESBURG PIKE STE 502
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City | VIENNA
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State | VA
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Zip | 22182-2714
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Country | US
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Telephone | 703-288-3299
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Fax | 703-288-3297
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. BRIAN ALEXANDER SUH
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Credential | DMD, PC
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Telephone | 703-288-3299
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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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