Organization
DRS MCILVEEN & FREEDMAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEZLEY P MCILVEEN DDS MS (PRESIDENT DENTIST)
(703) 689-3900
Entity
Organization
Contact information
Practice address
131 ELDEN ST, SUITE 130, HERNDON, VA 20170
(703) 689-3900
(703) 689-3903
Mailing address
131 ELDEN ST, SUITE 130, HERNDON, VA 20170
(703) 689-3900
(703) 689-3903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401-007357
VA
1223P0221X
Pediatric Dentistry
Primary
0401-006884
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401-006016
VA
Other
Enumeration date
01/29/2007
Last updated
07/23/2008
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