Individual
GARY ELLENBOGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8100 BOONE BLVD, VIENNA, VA 22182-2665
(703) 734-1095
(703) 714-9330
Mailing address
8100 BOONE BLVD, VIENNA, VA 22182-2665
(703) 734-1095
(703) 714-9330
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5562
VA
Other
Enumeration date
11/09/2006
Last updated
09/11/2013
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