| Ellis Orthodontics Pc | |
|
4600 John Marr Dr Ste 401 Annandale VA 22003-3310 | |
| (703) 750-9393 | |
| (703) 750-5420 |
| Full Name | Ellis Orthodontics Pc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4600 John Marr Dr Ste 401, Annandale, Virginia |
| Authorized Official Name and Position | Meghan Lindgren (OWNER) |
| Authorized Official Contact | 7039509393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Orthodontics Pc 4600 John Marr Dr Ste 401 Annandale VA 22003-3310 Ph: (703) 750-9393 | Ellis Orthodontics Pc 4600 John Marr Dr Ste 401 Annandale VA 22003-3310 Ph: (703) 750-9393 |
| NPI Number | 1588144125 |
|---|---|
| Provider Enumeration Date | 08/14/2018 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588144125 | NPI | - | NPPES |
| 040141131 | Other | VA | DENTAL LICENSE |
| 0401413318 | Other | VA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 040141131 (Virginia) | Primary |
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