Provider Demographics
NPI:1306367917
Name:LOMBARD ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:LOMBARD ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-777-8277
Mailing Address - Street 1:540 FORT EVANS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3379
Mailing Address - Country:US
Mailing Address - Phone:703-777-8277
Mailing Address - Fax:
Practice Address - Street 1:540 FORT EVANS RD STE 102
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3379
Practice Address - Country:US
Practice Address - Phone:703-777-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014155981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401415598Medicaid