Organization
DR. RICARDO GAITAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO MOISES GAITAN DDS/PC (DENTAL)
(703) 450-5302
Entity
Organization
Contact information
Practice address
21525 RIDGETOP CIR, SUITE #220, STERLING, VA 20166-6510
(703) 450-5302
(703) 450-5694
Mailing address
21525 RIDGETOP CIR, SUITE #220, STERLING, VA 20166-6510
(703) 450-5302
(703) 450-5694
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401008771
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203535828
TAX ID
VA
Enumeration date
05/13/2008
Last updated
05/13/2008
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