Organization
MERRIFIELD PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MONAMIE GHATAK DDS (OWNER)
(804) 306-4805
Entity
Organization
Contact information
Practice address
2301 GALLOWS RD STE 115, DUNN LORING, VA 22027-1149
(571) 293-1668
Mailing address
2722 MANHATTAN PL, VIENNA, VA 22180-7343
(804) 306-4805
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401411100
VA
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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