# LAKE MANASSA DENTAL CENTER

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

## Provider details

- **NPI number:** 1356539100
- **Authorized official:** LONG NGUYEN D.D.S. (MEMBER)
- **Authorized official phone:** (646) 641-8825

## Contact information

- **Practice address:** 7915 LAKE MANASSAS DR, STE 115, GAINESVILLE, VA 20155
- **Practice address phone:** (646) 641-8825
- **Mailing address:** 6911 STANWICK SQ, GAINESVILLE, VA 20155-4424
- **Mailing address phone:** (646) 641-8825

## Taxonomy

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

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 10/05/2007