Provider Demographics
NPI:1821134636
Name:DRS MCILVEEN & FREEDMAN PC
Entity Type:Organization
Organization Name:DRS MCILVEEN & FREEDMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEZLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCILVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:703-689-3900
Mailing Address - Street 1:131 ELDEN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-689-3900
Mailing Address - Fax:703-689-3903
Practice Address - Street 1:131 ELDEN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-689-3900
Practice Address - Fax:703-689-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0073571223G0001X
VA0401-0068841223P0221X
VA0401-0060161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty