# TJB OF DULLES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Loudoun Dental Associates & Smilez Pediatric Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457720302
- **Authorized official:** KERRI NICHOLS (REGIONAL DIRECTOR)
- **Authorized official phone:** (540) 494-8776

## Contact information

- **Practice address:** 24565 DULLES LANDING DR, SUITE 190, DULLES, VA 20166-2612
- **Practice address phone:** (703) 468-0188
- **Practice address fax:** (703) 754-1694
- **Mailing address:** 24565 DULLES LANDING DR, SUITE 190, DULLES, VA 20166-2612
- **Mailing address phone:** (703) 542-7300
- **Mailing address fax:** (703) 754-1694

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401007652 | VA | Yes |
| 261QD0000X | Dental Clinic/Center | 0401410720 | VA | — |

## Other

- **Enumeration date:** 09/22/2015
- **Last updated:** 09/22/2015