| Dental Center @ Lake Ridge | |
|
12764 Darby Brook Ct Woodbridge VA 22192-2486 | |
| (703) 499-8888 | |
| Not Available |
| Full Name | Dental Center @ Lake Ridge |
|---|---|
| Speciality | Clinic/center |
| Location | 12764 Darby Brook Ct, Woodbridge, Virginia |
| Authorized Official Name and Position | Thao Doan (OWNER) |
| Authorized Official Contact | 7034998888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Center @ Lake Ridge 12764 Darby Brook Ct Woodbridge VA 22192-2486 Ph: (703) 499-8888 | Dental Center @ Lake Ridge 12764 Darby Brook Ct Woodbridge VA 22192-2486 Ph: (703) 499-8888 |
| NPI Number | 1801242466 |
|---|---|
| Provider Enumeration Date | 05/12/2016 |
| Last Update Date | 05/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801242466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0401410245 (Virginia) | Primary |
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