Organization Name: | BBF DENTAL PLLC |
NPI Number: | 1003197955 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STAN KINDER (REGIONAL VICE PRESIDENT) |
Mailing Address: | 12011 Lee Jackson Hwy Suite 105 Fairfax |
State: | VA US |
Postal Code: | 220333310 |
Phone Number: | 7032735354 |
Fax Number: | 7032738149 |
NPI Enumeration Date: | 09/06/2011 |
NPI Last Update Date: | 09/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 401005817 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |