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General NPI Number Information
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NPI Number | 1841683471
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Entity Type | Organization
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Legal Business Name | COLUMBIA PIKE DENTAL PC
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 5555 COLUMBIA PIKE STE 102
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City | ARLINGTON
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State | VA
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Zip | 22204-3117
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Country | US
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Telephone | 703-820-8282
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Fax | 703-820-8283
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Provider Business Mailing Address
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Address Line | 5555 COLUMBIA PIKE STE 102
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City | ARLINGTON
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State | VA
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Zip | 22204-3117
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Country | US
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Telephone | 703-820-8282
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Fax | 703-820-8283
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNY O NGUYEN
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Credential |
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Telephone | 703-820-8282
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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 | 040112610
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License Number State | VA
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