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19415 Deerfield Ave Ste 309 Lansdowne VA 20176-8472 | |
| (703) 729-1818 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 19415 Deerfield Ave Ste 309, Lansdowne, Virginia |
| Authorized Official Name and Position | Wael Elosta (OWNER) |
| Authorized Official Contact | 7632214222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
19415 Deerfield Ave Ste 309 Lansdowne VA 20176-8472 Ph: (703) 729-1818 | 19415 Deerfield Ave Ste 309 Lansdowne VA 20176-8472 Ph: (703) 729-1818 |
| NPI Number | 1154747541 |
|---|---|
| Provider Enumeration Date | 03/10/2014 |
| Last Update Date | 03/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154747541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401412058 (Virginia) | Primary |
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