Organization
LAKE RIDGE ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADI F SALEH D.D.S,M.S. (OWNER)
(703) 491-5166
Entity
Organization
Contact information
Practice address
12662 LAKE RIDGE DR, SUITE A, WOODBRIDGE, VA 22192-7507
(703) 491-5166
(703) 494-4853
Mailing address
12662 LAKE RIDGE DR, SUITE A, WOODBRIDGE, VA 22192-7507
(703) 491-5166
(703) 494-4853
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0401412669
VA
Other
Enumeration date
12/27/2010
Last updated
12/27/2010
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