Provider Demographics
NPI:1619696754
Name:TYSONS DENTAL SPA
Entity Type:Organization
Organization Name:TYSONS DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-714-7374
Mailing Address - Street 1:8300 BOONE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2626
Mailing Address - Country:US
Mailing Address - Phone:703-714-7374
Mailing Address - Fax:703-714-7376
Practice Address - Street 1:8300 BOONE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2626
Practice Address - Country:US
Practice Address - Phone:703-714-7374
Practice Address - Fax:703-714-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental