Organization
DULLES ORAL SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD AUDUBORN LONGWE DDS (DIRECTOR)
(703) 327-0955
Entity
Organization
Contact information
Practice address
24805 PINEBROOK RD STE 100, CHANTILLY, VA 20152-4127
(703) 327-0955
(703) 327-0956
Mailing address
24805 PINEBROOK RD STE 100, CHANTILLY, VA 20152-4127
(703) 327-0955
(703) 327-0956
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0438000264
VA
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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