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DENTAL FAMILY PRACTICE NPI 1558483305


NPI Information

NPI: 1558483305
Provider Name: DENTAL FAMILY PRACTICE

Other Name: LAKE RIDGE DENTAL CLINIC

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
12724 DIRECTORS LOOP
LAKE RIDGE, VA
ZIP 22192
Phone: (703) 494-9171
Get Directions

DENTAL FAMILY PRACTICE is a general practice dentist in Lake Ridge, VA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DENTAL FAMILY PRACTICE NPI is 1558483305. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Lake Ridge Dental Clinic.

The provider's business location address is:

12724 DIRECTORS LOOP
LAKE RIDGE, VA
ZIP 22192-462
Phone: (703) 494-9171
Fax: (703) 490-4066

The provider's authorized official is Mina T Mostofi .
The authorized official title is Dentist and has the following contact phone number (703) 494-9171.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 6/23/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodontics0401008961VIRGINIANo
21223X0400XDentistOrthodontics and Dentofacial Orthopedics0401410790VIRGINIANo
31223G0001XDentistGeneral Practice0401007810VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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