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General NPI Number Information
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NPI Number | 1790932507
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Entity Type | Organization
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Legal Business Name | TEEM ORTHODONTICS PLLC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 14634 LEE HIGHWAY
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-753-4777
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Fax | 703-753-4677
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Provider Business Mailing Address
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Address Line | 14634 LEE HIGHWAY
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-753-4777
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Fax | 703-753-4677
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. MADUEKE ETHELBERTH EKOH
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Credential |
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Telephone | 703-753-4777
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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 | 0401411793
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License Number State | VA
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