| Innovation Dental Pllc | |
|
9940 Sowder Village Square Manassas VA 20109 | |
| (703) 330-3933 | |
| (703) 330-3517 |
| Full Name | Innovation Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9940 Sowder Village Square, Manassas, Virginia |
| Authorized Official Name and Position | Borarath Mak Yann (OWNER) |
| Authorized Official Contact | 7033303933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovation Dental Pllc 9940 Sowder Village Square Manassas VA 20109 Ph: (703) 330-3933 | Innovation Dental Pllc 9940 Sowder Village Square Manassas VA 20109 Ph: (703) 330-3933 |
| NPI Number | 1225264302 |
|---|---|
| Provider Enumeration Date | 06/03/2009 |
| Last Update Date | 06/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225264302 | NPI | - | NPPES |
| 1083887194 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0401410448 (Virginia) | Primary |
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