Provider Demographics
NPI:1497127690
Name:NORTHERN VIRGINIA DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOAYZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-451-8332
Mailing Address - Street 1:6116 ROLLING RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1521
Mailing Address - Country:US
Mailing Address - Phone:703-451-8332
Mailing Address - Fax:703-451-4661
Practice Address - Street 1:6116 ROLLING RD
Practice Address - Street 2:SUITE 316
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1521
Practice Address - Country:US
Practice Address - Phone:703-451-8332
Practice Address - Fax:703-451-4661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty