# LEESBURG DENTAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063113199
- **Authorized official:** GEITH KALLAS DDS (OWNER)
- **Authorized official phone:** (703) 622-3300

## Contact information

- **Practice address:** 19 CATOCTIN CIR NE, LEESBURG, VA 20176-3100
- **Practice address phone:** (703) 737-0070
- **Mailing address:** 8310 OLD COURTHOUSE RD STE A, VIENNA, VA 22182-3872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2023
- **Last updated:** 08/23/2023