Provider Demographics
NPI:1770362295
Name:TYSONS CORNER ENDODONTICS
Entity type:Organization
Organization Name:TYSONS CORNER ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:703-288-3299
Mailing Address - Street 1:8150 LEESBURG PIKE STE 502
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:703-288-3299
Mailing Address - Fax:703-288-3297
Practice Address - Street 1:8150 LEESBURG PIKE STE 502
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2714
Practice Address - Country:US
Practice Address - Phone:703-288-3299
Practice Address - Fax:703-288-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental