Organization
SOUTH RIDING ORAL AND IMPLANT SURGERY
Active
Other names
South Riding Oral and Implant Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMRAN RAJA DMD, MD (OWNER)
(571) 218-0878
Entity
Organization
Contact information
Practice address
24805 PINEBROOK RD # 318, CHANTILLY, VA 20152-4126
(571) 218-0878
Mailing address
9209 MAROVELLI FOREST DR, LORTON, VA 22079-3456
(571) 218-0878
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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