Provider Demographics
NPI:1255789541
Name:METRO DENTAL HEALTH PLLC
Entity type:Organization
Organization Name:METRO DENTAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:703-934-4474
Mailing Address - Street 1:8370 GREENSBORO DR
Mailing Address - Street 2:APT 901
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3515
Mailing Address - Country:US
Mailing Address - Phone:703-934-4474
Mailing Address - Fax:703-934-4705
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:SUITE 203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-363-5720
Practice Address - Fax:703-934-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty