Provider Demographics
NPI:1386999282
Name:MERRIFIELD ORTHODONTICS PLLC
Entity type:Organization
Organization Name:MERRIFIELD ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:WON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-573-0200
Mailing Address - Street 1:2843 HARTLAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3527
Mailing Address - Country:US
Mailing Address - Phone:703-573-0200
Mailing Address - Fax:
Practice Address - Street 1:2843 HARTLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3527
Practice Address - Country:US
Practice Address - Phone:703-573-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty