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General NPI Number Information
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NPI Number | 1992245724
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST SLEEP PROGRAM
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 230 FORT EVANS RD NE
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City | LEESBURG
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State | VA
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Zip | 20176-4497
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Country | US
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Telephone | 703-967-2624
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Fax | 703-777-7202
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Provider Business Mailing Address
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Address Line | 230 FORT EVANS RD NE
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City | LEESBURG
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State | VA
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Zip | 20176-4497
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Country | US
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Telephone | 703-967-2624
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Fax | 703-777-7202
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. RONALD BURO
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Credential | DDS
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Telephone | 703-967-2624
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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 | 0401410970
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License Number State | VA
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