Organization
LAKE RIDGE DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIUMARS KARBASI DDS (OWNER)
(571) 335-6194
Entity
Organization
Contact information
Practice address
13625 OFFICE PL STE 102, WOODBRIDGE, VA 22192-4270
(703) 670-7071
(703) 590-6292
Mailing address
13625 OFFICE PL STE 102, WOODBRIDGE, VA 22192-4270
(703) 670-7071
(703) 590-6292
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401414080
VA
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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