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680 Potomac Station Dr Ne Leesburg VA 20176-1839 | |
| (571) 209-9197 | |
| (571) 209-5316 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 680 Potomac Station Dr Ne, Leesburg, Virginia |
| Authorized Official Name and Position | Hillary Thull (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408946 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
680 Potomac Station Dr Ne Leesburg VA 20176-1839 Ph: (571) 209-9197 | 680 Potomac Station Dr Ne Leesburg VA 20176-1839 Ph: (571) 209-9197 |
| NPI Number | 1639446263 |
|---|---|
| Provider Enumeration Date | 11/28/2011 |
| Last Update Date | 11/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639446263 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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