Organization
MODERN ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKOLAY DIMITROV MOLLOV DDS, MS (VICE-PRESIDENT)
(703) 436-0006
Entity
Organization
Contact information
Practice address
10298 BRISTOW CENTER DR, BRISTOW, VA 20136-2200
(703) 436-0006
Mailing address
10298 BRISTOW CENTER DR, BRISTOW, VA 20136-2200
(703) 436-0006
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0401413531
VA
Other
Enumeration date
11/06/2013
Last updated
01/10/2014
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