Organization
GD VA LEESBURG PIKE PLLC
Active
Other names
Tysons Aesthetic Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
8150 LEESBURG PIKE STE 503, VIENNA, VA 22182-2714
(703) 532-2020
Mailing address
8150 LEESBURG PIKE STE 503, VIENNA, VA 22182-2714
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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