Provider Demographics
NPI:1023741667
Name:BOBBIO FAMILY DENTAL AT BIRCHWOOD
Entity type:Organization
Organization Name:BOBBIO FAMILY DENTAL AT BIRCHWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:BOBBIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-402-0281
Mailing Address - Street 1:42206 BUNKER WOODS PL
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6434
Mailing Address - Country:US
Mailing Address - Phone:703-402-0281
Mailing Address - Fax:
Practice Address - Street 1:23710 SCHOOLER PLAZA #215
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148
Practice Address - Country:US
Practice Address - Phone:703-402-0281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164727889OtherNPI