Provider Demographics
NPI:1134449341
Name:THE VIRGINIA ENDODONTIC GROUP - KINGSTOWNE
Entity type:Organization
Organization Name:THE VIRGINIA ENDODONTIC GROUP - KINGSTOWNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TU-SON
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-378-3115
Mailing Address - Street 1:14149 ROBERT PARIS CT STE B
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6831 SIR VICEROY DR STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3713
Practice Address - Country:US
Practice Address - Phone:703-922-9040
Practice Address - Fax:703-922-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental