# GD VA LEESBURG PIKE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tysons Aesthetic Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184459828
- **Authorized official:** CHAD HENDRICKS (CREDENTIALING)
- **Authorized official phone:** (612) 859-0444

## Contact information

- **Practice address:** 8150 LEESBURG PIKE STE 503, VIENNA, VA 22182-2714
- **Practice address phone:** (703) 532-2020
- **Mailing address:** 8150 LEESBURG PIKE STE 503, VIENNA, VA 22182-2714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2024
- **Last updated:** 09/03/2024