Provider Demographics
NPI:1316283930
Name:LOUDOUN PERIODONTICS, PLLC
Entity type:Organization
Organization Name:LOUDOUN PERIODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:PFOHL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-430-0938
Mailing Address - Street 1:14 PIDGEON HILL DRIVE, SUITE 360
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165
Mailing Address - Country:US
Mailing Address - Phone:703-430-0938
Mailing Address - Fax:703-450-2257
Practice Address - Street 1:14 PIDGEON HILL DR STE 360
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6133
Practice Address - Country:US
Practice Address - Phone:703-430-0938
Practice Address - Fax:703-450-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007512261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental