Island Childrens Dentistry PLLC
Dentist, Pediatric Dentistry in Vienna, VA. Organization (NPI-2).
NPI number1962071019
StatusActive
Last updated in NPPESJun 23, 2021
Details
- NPI
- 1962071019
- Entity type
- Organization (NPI-2)
- Legal business name
- Island Childrens Dentistry PLLC
- Organization subpart
- No
- Enumeration date
- Jun 23, 2021
- Certification date
- Jun 23, 2021
- Last updated
- Jun 23, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | – | – | Yes |
Other names
- Island Childrens Dentistry (Doing Business As)
Practice location
1500 Cornerside Blvd Ste 310Vienna, VA 22182-2438
Phone 703-790-1320 · Fax 703-790-0455
Mailing address
1500 Cornerside Blvd Ste 310Vienna, VA 22182-2438
Phone 703-790-1320 · Fax 703-790-0455
Authorized official
Maria Gema Island
Owner
7037901320
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