| Daczkowski Orthodontics | |
|
8715 Stonewall Road Manassas VA 20110 | |
| (703) 361-4278 | |
| (703) 361-2449 |
| Full Name | Daczkowski Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 8715 Stonewall Road, Manassas, Virginia |
| Authorized Official Name and Position | Telisa Lynn Kidd-wise (PRACTICE MANAGER) |
| Authorized Official Contact | 7033614278 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Daczkowski Orthodontics 8715 Stonewall Road Manassas VA 20110 Ph: (703) 361-4278 | Daczkowski Orthodontics 8715 Stonewall Road Manassas VA 20110 Ph: (703) 361-4278 |
| NPI Number | 1093186512 |
|---|---|
| Provider Enumeration Date | 10/09/2015 |
| Last Update Date | 02/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093186512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 0401410230 (Virginia) | Primary |
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