Provider Demographics
NPI:1528222171
Name:LEESBURG DENTAL P C
Entity Type:Organization
Organization Name:LEESBURG DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-777-2442
Mailing Address - Street 1:602 S KING ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3919
Mailing Address - Country:US
Mailing Address - Phone:703-777-2442
Mailing Address - Fax:703-777-1510
Practice Address - Street 1:602 S KING ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3919
Practice Address - Country:US
Practice Address - Phone:703-777-2442
Practice Address - Fax:703-777-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty