Provider Demographics
NPI:1013304401
Name:BRITTO ORTHODONTICS
Entity Type:Organization
Organization Name:BRITTO ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-230-6784
Mailing Address - Street 1:12581 MILSTEAD WAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5445
Mailing Address - Country:US
Mailing Address - Phone:703-583-6784
Mailing Address - Fax:703-230-0509
Practice Address - Street 1:12581 MILSTEAD WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5445
Practice Address - Country:US
Practice Address - Phone:703-583-6784
Practice Address - Fax:703-230-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty