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7746 Gunston Plz Lorton VA 22079-1897 | |
| (703) 348-6969 | |
| (540) 808-1580 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7746 Gunston Plz, Lorton, Virginia |
| Authorized Official Name and Position | Assefa Demewoz (OWNER) |
| Authorized Official Contact | 7033486969 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7746 Gunston Plz Lorton VA 22079-1897 Ph: (703) 348-6969 | 7746 Gunston Plz Lorton VA 22079-1897 Ph: (703) 348-6969 |
| NPI Number | 1205338118 |
|---|---|
| Provider Enumeration Date | 03/06/2018 |
| Last Update Date | 03/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205338118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401413725 (Virginia) | Primary |
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