Provider Demographics
NPI:1821284431
Name:PETER L PASSERO DDS & BRIAN A FEENEY DMD PLC
Entity Type:Organization
Organization Name:PETER L PASSERO DDS & BRIAN A FEENEY DMD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PASSERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-821-4040
Mailing Address - Street 1:1430 SPRING HILL ROAD
Mailing Address - Street 2:#101
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3013
Mailing Address - Country:US
Mailing Address - Phone:703-821-4040
Mailing Address - Fax:703-821-4041
Practice Address - Street 1:1430 SPRING HILL ROAD
Practice Address - Street 2:#101
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3013
Practice Address - Country:US
Practice Address - Phone:703-821-4040
Practice Address - Fax:703-821-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052651223P0300X
VA04014103731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty