Organization
PURCELLVILLE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOOSHIN MONAJEMY (OWNER)
(540) 447-7627
Entity
Organization
Contact information
Practice address
17333 PICKWICK DR, PURCELLVILLE, VA 20132
(540) 441-7627
Mailing address
17333 PICKWICK DR, PURCELLVILLE, VA 20132-6173
(540) 441-7627
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401410184
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008220191
—
VA
Enumeration date
05/10/2013
Last updated
05/10/2013
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