Organization
TDG DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (CREDENTIALING SUPERVISOR)
(305) 274-2499
Entity
Organization
Contact information
Practice address
3114 GOLANSKY BLVD STE 101, WOODBRIDGE, VA 22192-4231
(703) 583-2800
Mailing address
3114 GOLANSKY BLVD STE 101, WOODBRIDGE, VA 22192-4231
(703) 583-2800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/16/2018
Last updated
11/16/2018
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