| Lake Ridge Endodontics | |
|
12510 C Lake Ridge Dr Woodbridge VA 22192-2335 | |
| (703) 494-8624 | |
| (703) 497-1258 |
| Full Name | Lake Ridge Endodontics |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 12510 C Lake Ridge Dr, Woodbridge, Virginia |
| Authorized Official Name and Position | Todd E Wynkoop (OWNER/ENDODOTONTIST) |
| Authorized Official Contact | 7034948624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Ridge Endodontics 12510 Lake Ridge Dr Ste C Lake Ridge VA 22192-7501 Ph: (703) 494-8624 | Lake Ridge Endodontics 12510 C Lake Ridge Dr Woodbridge VA 22192-2335 Ph: (703) 494-8624 |
| NPI Number | 1205933405 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 07/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205933405 | NPI | - | NPPES |
| 872859 | Other | UNITED CONCORDIA | |
| 174982 | Other | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 041007464 (Virginia) | Primary |
Michael Morch D.d.s. P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3138 Golansky Blvd, Suite 101, Woodbridge, VA 22192 Phone: 703-878-7969 Fax: 703-730-9907 | |
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