Provider Demographics
NPI:1497111892
Name:NOVA CENTER FOR DENTAL SLEEP TREATMENT PLLC
Entity Type:Organization
Organization Name:NOVA CENTER FOR DENTAL SLEEP TREATMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-559-3419
Mailing Address - Street 1:8310 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8310 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3872
Practice Address - Country:US
Practice Address - Phone:703-559-3419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty