# INNOVATION DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellington Dental Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225264302
- **Authorized official:** BORARATH MAK YANN D.D.S. (OWNER)
- **Authorized official phone:** (703) 330-3933

## Contact information

- **Practice address:** 9940 SOWDER VILLAGE SQUARE, MANASSAS, VA 20109
- **Practice address phone:** (703) 330-3933
- **Practice address fax:** (703) 330-3517
- **Mailing address:** 9940 SOWDER VILLAGE SQUARE, MANASSAS, VA 20109
- **Mailing address phone:** (703) 330-3933
- **Mailing address fax:** (703) 330-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401410448 | VA | Yes |

## Other

- **Enumeration date:** 06/03/2009
- **Last updated:** 06/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1083887194 | — | VA |