Organization
SOUTH FORK DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIMREN MAHAL DDS (OWNER)
(571) 335-7480
Entity
Organization
Contact information
Practice address
723 E MAIN ST, PURCELLVILLE, VA 20132
(571) 335-7480
Mailing address
19783 WILLOWDALE PL, ASHBURN, VA 20147-5209
(703) 297-6793
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922408160
NPI
—
Enumeration date
12/06/2021
Last updated
12/06/2021
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