Provider Demographics
NPI:1073733424
Name:BAMBREY, DINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:BAMBREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20773 RESERVE FALLS TER
Mailing Address - Street 2:#204
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6549
Mailing Address - Country:US
Mailing Address - Phone:703-948-6581
Mailing Address - Fax:
Practice Address - Street 1:44025 PIPELINE PLZ
Practice Address - Street 2:#120
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5881
Practice Address - Country:US
Practice Address - Phone:703-726-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice