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General NPI Number Information
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NPI Number | 1932963790
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Entity Type | Organization
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Legal Business Name | WEST END IMPLANTS AND PERIODONTICS, PLLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 7915 LAKE MANASSAS DR STE 207
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City | GAINESVILLE
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State | VA
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Zip | 20155-3260
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Country | US
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Telephone | 571-261-4867
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Fax | 571-261-2522
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Provider Business Mailing Address
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Address Line | 7915 LAKE MANASSAS DR STE 207
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City | GAINESVILLE
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State | VA
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Zip | 20155-3260
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Country | US
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Telephone | 571-261-4867
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Fax | 571-261-2522
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | REBECCA L BLAN
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Credential |
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Telephone | 571-261-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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