# M MINNIEVILLE DENTAL CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOMENTUM DENTAL CARE
- **Other names:** Momentum Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952907842
- **Legal business name:** MOMENTUM DENTAL CARE
- **Authorized official:** GELLY RIVAS OSORIO (OPERATIONS MANAGER)
- **Authorized official phone:** (703) 589-7040

## Contact information

- **Practice address:** 14389 HEREFORD RD, WOODBRIDGE, VA 22193-2107
- **Practice address phone:** (703) 878-8000
- **Mailing address:** 4222 FORTUNA CENTER PLZ \# 637, DUMFRIES, VA 22025-1515

## Taxonomy

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

## Other

- **Enumeration date:** 12/07/2020
- **Last updated:** 02/17/2021