Organization
INNOVATION DENTAL PLLC
Active
Other names
Wellington Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
BORARATH MAK YANN D.D.S. (OWNER)
(703) 330-3933
Entity
Organization
Contact information
Practice address
9940 SOWDER VILLAGE SQUARE, MANASSAS, VA 20109
(703) 330-3933
(703) 330-3517
Mailing address
9940 SOWDER VILLAGE SQUARE, MANASSAS, VA 20109
(703) 330-3933
(703) 330-3517
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410448
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083887194
—
VA
Enumeration date
06/03/2009
Last updated
06/03/2009
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