Provider Demographics
NPI:1588235303
Name:VICTORY DENTAL LLC
Entity Type:Organization
Organization Name:VICTORY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSHYNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-486-2593
Mailing Address - Street 1:5 LAKENHEATH CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2734
Mailing Address - Country:US
Mailing Address - Phone:202-486-2593
Mailing Address - Fax:
Practice Address - Street 1:1104 KENILWORTH DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2101
Practice Address - Country:US
Practice Address - Phone:202-486-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental