Organization
ADDAX DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DOE DMD (MANAGING CLINICAL DIRECTOR)
(703) 777-5939
Entity
Organization
Contact information
Practice address
546 E MARKET ST, LEESBURG, VA 20176-4112
(703) 777-5939
Mailing address
546 E MARKET ST, LEESBURG, VA 20176-4112
(703) 777-5939
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401413091
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110088059A
—
MA
Enumeration date
01/18/2012
Last updated
01/18/2012
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