Organization
LOUDOUN ENDODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW SCOTT DETAR DDS, MSD (OWNER/ENDODONTIST)
(703) 368-8120
Entity
Organization
Contact information
Practice address
2 CARDINAL PARK DR SE STE 106A, LEESBURG, VA 20175-4448
(703) 779-7900
Mailing address
14426 BECKETT GLEN CIR, CHANTILLY, VA 20151-2140
(703) 851-6885
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
05/30/2022
Last updated
05/30/2022
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