Provider Demographics
NPI:1114075843
Name:ASHBURN CHILDRENS DENTISTRY
Entity Type:Organization
Organization Name:ASHBURN CHILDRENS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN-DURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-786-5199
Mailing Address - Street 1:44025 PIPELINE PLZ
Mailing Address - Street 2:UNIT 1-225
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5881
Mailing Address - Country:US
Mailing Address - Phone:703-723-8440
Mailing Address - Fax:703-723-8443
Practice Address - Street 1:44025 PIPELINE PLZ
Practice Address - Street 2:UNIT 1-225
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5881
Practice Address - Country:US
Practice Address - Phone:703-723-8440
Practice Address - Fax:703-723-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty