Organization
SMALL SMILES OF MANASSAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRUDY WILLIAMS (DIRECTOR, LICENSING & CREDENTIALING)
(615) 750-0342
Entity
Organization
Contact information
Practice address
9012 MATHIS AVE, MANASSAS, VA 20110-5218
(571) 921-1111
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
05/17/2010
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