Provider Demographics
NPI:1003197955
Name:BBF DENTAL PLLC
Entity Type:Organization
Organization Name:BBF DENTAL PLLC
Other - Org Name:DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-298-1690
Mailing Address - Street 1:12701 FAIR LAKES CIR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4910
Mailing Address - Country:US
Mailing Address - Phone:703-269-3150
Mailing Address - Fax:703-449-9865
Practice Address - Street 1:12011 LEE JACKSON HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3310
Practice Address - Country:US
Practice Address - Phone:703-273-5354
Practice Address - Fax:703-273-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401005817261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental