Organization
TJB OF DULLES, LLC
Active
Other names
Loudoun Dental Associates & Smilez Pediatric Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI NICHOLS (REGIONAL DIRECTOR)
(540) 494-8776
Entity
Organization
Contact information
Practice address
24565 DULLES LANDING DR, SUITE 190, DULLES, VA 20166-2612
(703) 468-0188
(703) 754-1694
Mailing address
24565 DULLES LANDING DR, SUITE 190, DULLES, VA 20166-2612
(703) 542-7300
(703) 754-1694
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401007652
VA
261QD0000X
Dental Clinic/Center
0401410720
VA
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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