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14535 John Marshall Hwy Ste 209 Gainesville VA 20155-4025 | |
| (703) 753-2252 | |
| (703) 753-2268 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 14535 John Marshall Hwy Ste 209, Gainesville, Virginia |
| Authorized Official Name and Position | Kimberley Olsen (DENTIST/MEMBER OWNER) |
| Authorized Official Contact | 7037532252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14535 John Marshall Hwy Ste 209 Gainesville VA 20155-4025 Ph: (703) 753-2252 | 14535 John Marshall Hwy Ste 209 Gainesville VA 20155-4025 Ph: (703) 753-2252 |
| NPI Number | 1558855619 |
|---|---|
| Provider Enumeration Date | 06/21/2018 |
| Last Update Date | 06/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558855619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401410917 (Virginia) | Primary |
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