Provider Demographics
NPI:1811782667
Name:DENTISTS OF BRISTOW
Entity type:Organization
Organization Name:DENTISTS OF BRISTOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDANY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-383-1103
Mailing Address - Street 1:12701 BRAEMAR VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5501
Mailing Address - Country:US
Mailing Address - Phone:571-500-7411
Mailing Address - Fax:
Practice Address - Street 1:12701 BRAEMAR VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5501
Practice Address - Country:US
Practice Address - Phone:571-500-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty