Provider Demographics
NPI:1750046454
Name:LION DENTAL PLLC
Entity Type:Organization
Organization Name:LION DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-617-8462
Mailing Address - Street 1:30 SHORT BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4635
Mailing Address - Country:US
Mailing Address - Phone:313-617-8462
Mailing Address - Fax:
Practice Address - Street 1:9821 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9422
Practice Address - Country:US
Practice Address - Phone:313-617-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental