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Organization
BRADLEY D WILTBANK DMD PC
Active
Organization
BRADLEY D WILTBANK DMD PC
Active
Other names
Dolley Madison Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD D WILTBANK DMD (OWNER)
(703) 356-7890
Entity
Organization
Contact information
Practice address
1313 DOLLEY MADISON BLVD STE 209, MC LEAN, VA 22101-3926
(703) 356-7890
Mailing address
1313 DOLLEY MADISON BLVD STE 209, MC LEAN, VA 22101-3926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
NULL
Other
Enumeration date
08/28/2014
Last updated
09/08/2014
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