Provider Demographics
NPI:1396020848
Name:DENTAL CENTER OF MERRIFIELD INC
Entity type:Organization
Organization Name:DENTAL CENTER OF MERRIFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-798-3964
Mailing Address - Street 1:2841 HARTLAND RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043
Mailing Address - Country:US
Mailing Address - Phone:703-663-8859
Mailing Address - Fax:703-663-8138
Practice Address - Street 1:2841 HARTLAND RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-663-8859
Practice Address - Fax:703-663-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401411116122300000X
VA401412557122300000X
VA401102428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty