Organization
ELLIS ORTHODONTICS PC
Active
Organization
ELLIS ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGHAN LINDGREN DDS (OWNER)
(703) 950-9393
Entity
Organization
Contact information
Practice address
4600 JOHN MARR DR STE 401, ANNANDALE, VA 22003-3310
(703) 750-9393
(703) 750-5420
Mailing address
4600 JOHN MARR DR STE 401, ANNANDALE, VA 22003-3310
(703) 750-9393
(703) 750-5420
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
040141131
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040141131
DENTAL LICENSE
VA
01
—
0401413318
DENTAL LICENSE
VA
Enumeration date
08/14/2018
Last updated
06/11/2019
Update your record
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