Provider Demographics
NPI:1932963790
Name:WEST END IMPLANTS AND PERIODONTICS, PLLC
Entity Type:Organization
Organization Name:WEST END IMPLANTS AND PERIODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-261-4867
Mailing Address - Street 1:7915 LAKE MANASSAS DR STE 207
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3260
Mailing Address - Country:US
Mailing Address - Phone:571-261-4867
Mailing Address - Fax:571-261-2522
Practice Address - Street 1:7915 LAKE MANASSAS DR STE 207
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3260
Practice Address - Country:US
Practice Address - Phone:571-261-4867
Practice Address - Fax:571-261-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty