Organization
DULLES OROFACIAL SURGERY
Active
Parent organization
DULLES ORAL SURGICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
DULLES ORAL SURGICAL CENTER
Authorized official
EDWARD LONGWE DDS (OFFICE MANAGER)
(703) 327-0955
Entity
Organization
Contact information
Practice address
24805 PINEBROOK RD, SUITE 100, CHANTILLY, VA 20152-4126
(703) 327-0955
(703) 327-0956
Mailing address
24805 PINEBROOK RD, SUITE 100, CHANTILLY, VA 20152-4126
(703) 327-0955
(703) 327-0956
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0438000358
VA
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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