Provider Demographics
NPI:1033508734
Name:VIRGINIA DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:VIRGINIA DENTAL PARTNERS PLLC
Other - Org Name:SUDLEY MANOR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:OSSAKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-862-8577
Mailing Address - Street 1:10482 SUDLEY MANOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109
Mailing Address - Country:US
Mailing Address - Phone:703-369-9100
Mailing Address - Fax:703-365-2000
Practice Address - Street 1:10482 SUDLEY MANOR DRIVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-369-9100
Practice Address - Fax:703-365-2000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-19
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty