Provider Demographics
NPI:1962821496
Name:LOUDOUN FAMILY AND COSMETIC DENTISTRY
Entity type:Organization
Organization Name:LOUDOUN FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-858-9067
Mailing Address - Street 1:44125 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6839
Mailing Address - Country:US
Mailing Address - Phone:703-858-9067
Mailing Address - Fax:703-858-9267
Practice Address - Street 1:44125 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6839
Practice Address - Country:US
Practice Address - Phone:703-858-9067
Practice Address - Fax:703-858-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty