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Dental Providers Dentist Orthodontics and Dentofacial Orthopedics

Provider NPI: 1154530533

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
2535 CHAIN BRIDGE RD  VIENNA, VA 22181-5538 US
Tel: 703-938-4614  Fax: 703-938-6459

Business Mailing Address:
2535 CHAIN BRIDGE RD  VIENNA, VA 22181-5538 US
Tel: 703-938-4614  Fax: 703-938-6459

NPI Information:
NPI: 1154530533
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223X0400XDental Providers
Orthodontics and Dentofacial Orthopedics

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223X0400X





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