Provider Demographics
NPI:1316162456
Name:SPRINGFIELD ORTHODONTIC ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SPRINGFIELD ORTHODONTIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-719-5828
Mailing Address - Street 1:6564 LOISDALE CT STE 325
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1831
Mailing Address - Country:US
Mailing Address - Phone:703-719-5828
Mailing Address - Fax:703-719-9193
Practice Address - Street 1:6564 LOISDALE CT STE 325
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1831
Practice Address - Country:US
Practice Address - Phone:703-719-5828
Practice Address - Fax:703-719-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007980305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization