Provider Demographics
NPI:1649486747
Name:DULLES DENTAL GROUP LLC
Entity type:Organization
Organization Name:DULLES DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-802-8999
Mailing Address - Street 1:5103 WESTFIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120
Mailing Address - Country:US
Mailing Address - Phone:703-802-8999
Mailing Address - Fax:703-802-4704
Practice Address - Street 1:5103 WESTFIELDS BLVD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120
Practice Address - Country:US
Practice Address - Phone:703-802-8999
Practice Address - Fax:703-802-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty