Organization Name: | DULLES ORAL SURGICAL CENTER |
NPI Number: | 1992011233 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWARD AUDUBORN LONGWE (DIRECTOR) |
Mailing Address: | 24805 Pinebrook Rd Ste 100 Chantilly |
State: | VA US |
Postal Code: | 201524127 |
Phone Number: | 7033270955 |
Fax Number: | 7033270956 |
NPI Enumeration Date: | 08/24/2010 |
NPI Last Update Date: | 08/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | 0438000264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |