Provider Demographics
NPI:1275716581
Name:J. DANIEL LABRIOLA DDS AND DAVID J CANTOR DMD PC
Entity Type:Organization
Organization Name:J. DANIEL LABRIOLA DDS AND DAVID J CANTOR DMD PC
Other - Org Name:NORTHERN VIRGINIA ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LABRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-256-2307
Mailing Address - Street 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 101-E
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2611
Mailing Address - Country:US
Mailing Address - Phone:703-256-2307
Mailing Address - Fax:703-256-3230
Practice Address - Street 1:7611 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 101-E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2611
Practice Address - Country:US
Practice Address - Phone:703-256-2307
Practice Address - Fax:703-256-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01577Medicare PIN