Provider Demographics
NPI:1437438918
Name:CROSSPOINT DENTAL CARE PC
Entity Type:Organization
Organization Name:CROSSPOINT DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-914-1113
Mailing Address - Street 1:7535 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 310-C
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2937
Mailing Address - Country:US
Mailing Address - Phone:703-914-1113
Mailing Address - Fax:703-914-1120
Practice Address - Street 1:7535 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 310-C
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2937
Practice Address - Country:US
Practice Address - Phone:703-914-1113
Practice Address - Fax:703-914-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4014124181223G0001X
VA4014125431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty