Provider Demographics
NPI:1689899726
Name:CLEAR CARE DENTAL PLLC.
Entity Type:Organization
Organization Name:CLEAR CARE DENTAL PLLC.
Other - Org Name:FREDRICKSBURG ORTHODONTICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-785-4474
Mailing Address - Street 1:10 CHATHAM HEIGHTS RD.
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405
Mailing Address - Country:US
Mailing Address - Phone:540-785-4494
Mailing Address - Fax:540-785-2216
Practice Address - Street 1:10 CHATHAM HEIGHTS RD.
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405
Practice Address - Country:US
Practice Address - Phone:540-785-4494
Practice Address - Fax:540-785-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007980305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization