Individual
JAY BRIAN QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
102 ELDEN ST, SUITE 20, HERNDON, VA 20170-4868
(703) 689-2480
Mailing address
102 ELDEN ST, SUITE 20, HERNDON, VA 20170-4868
(703) 689-2480
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
401007661
VA
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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