Provider Demographics
NPI:1447611959
Name:GENTLE FAMILY DENTISTRY OF LEESBURG PC
Entity Type:Organization
Organization Name:GENTLE FAMILY DENTISTRY OF LEESBURG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-737-0070
Mailing Address - Street 1:19 CATOCTIN CIR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3100
Mailing Address - Country:US
Mailing Address - Phone:703-737-0070
Mailing Address - Fax:703-737-0075
Practice Address - Street 1:19 CATOCTIN CIR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3100
Practice Address - Country:US
Practice Address - Phone:703-737-0070
Practice Address - Fax:703-737-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty