Provider Demographics
NPI:1659643005
Name:AM CUJAR DDS & ASSOCIATES S-CORP
Entity type:Organization
Organization Name:AM CUJAR DDS & ASSOCIATES S-CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-889-5420
Mailing Address - Street 1:104 ELDEN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4871
Mailing Address - Country:US
Mailing Address - Phone:703-889-5420
Mailing Address - Fax:703-889-5419
Practice Address - Street 1:104 ELDEN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4871
Practice Address - Country:US
Practice Address - Phone:703-889-5420
Practice Address - Fax:703-889-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411978261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental