Provider Demographics
NPI:1760684146
Name:CASCADES DENTAL OF CENTREVILLE
Entity Type:Organization
Organization Name:CASCADES DENTAL OF CENTREVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:AUNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-266-2483
Mailing Address - Street 1:6134 REDWOOD SQUARE CENTER SUITE 202
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-266-2483
Mailing Address - Fax:703-266-9300
Practice Address - Street 1:6134 REDWOOD SQUARE CENTER SUITE 202
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-266-2483
Practice Address - Fax:703-266-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA68161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty