Individual
MS. NICOLE VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S, P.C.
Contact information
Practice address
139A CHURCH ST NW, VIENNA, VA 22180-4508
(703) 556-0091
Mailing address
139A CHURCH ST NW, VIENNA, VA 22180-4508
(703) 556-0091
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008633
VA
Other
Enumeration date
03/08/2007
Last updated
12/11/2024
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