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Organization
NOVA DENTAL
Active
Organization
NOVA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD SUN DDS (PRESIDENT)
(571) 313-1535
Entity
Organization
Contact information
Practice address
11872 SUNRISE VALLEY DR, SUITE 101, RESTON, VA 20191-3321
(571) 313-1535
Mailing address
11872 SUNRISE VALLEY DR, SUITE 101, RESTON, VA 20191-3321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401411269
VA
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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