| Amc Dental Spa | |
|
104 Elden St Suite 10 Herndon VA 20170-4871 | |
| (703) 889-5420 | |
| (703) 889-5419 |
| Full Name | Amc Dental Spa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 104 Elden St, Herndon, Virginia |
| Authorized Official Name and Position | Camilo Cujar (GENERAL MANAGER) |
| Authorized Official Contact | 7038895420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amc Dental Spa 104 Elden St Suite 10 Herndon VA 20170-4871 Ph: (703) 889-5420 | Amc Dental Spa 104 Elden St Suite 10 Herndon VA 20170-4871 Ph: (703) 889-5420 |
| NPI Number | 1659643005 |
|---|---|
| Provider Enumeration Date | 02/01/2012 |
| Last Update Date | 02/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659643005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401411978 (Virginia) | Primary |
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