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Organization

LEGACY DENTAL IMPLANT OF HERNDON

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ABDELROUF SUWID (OWNER)
(646) 824-3829
Entity
Organization

Contact information

Practice address
208 ELDEN ST, HERNDON, VA 20170-4877
(646) 824-3829
Mailing address
208 ELDEN ST, HERNDON, VA 20170-4877
(646) 824-3829

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary

Other

Enumeration date
07/08/2025
Last updated
07/08/2025
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