Provider Demographics
NPI:1699498493
Name:EXCELSIOR ORTHODONTICS PLLC
Entity type:Organization
Organization Name:EXCELSIOR ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:540-751-8826
Mailing Address - Street 1:205 HIRST RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6199
Mailing Address - Country:US
Mailing Address - Phone:540-751-8826
Mailing Address - Fax:
Practice Address - Street 1:205 HIRST RD STE 105
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6199
Practice Address - Country:US
Practice Address - Phone:540-751-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty