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Organization
LEGACY DENTAL IMPLANT OF HERNDON
Active
Organization
LEGACY DENTAL IMPLANT OF HERNDON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDELROUF SUWID (OWNER)
(646) 824-3829
Entity
Organization
Contact information
Practice address
208 ELDEN ST, HERNDON, VA 20170-4877
(646) 824-3829
Mailing address
208 ELDEN ST, HERNDON, VA 20170-4877
(646) 824-3829
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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