| Life Bridge Dental Va Pllc | |
|
4201 Wilson Blvd Ste 190 Arlington VA 22203-4147 | |
| (212) 686-3686 | |
| (615) 468-0325 |
| Full Name | Life Bridge Dental Va Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4201 Wilson Blvd Ste 190, Arlington, Virginia |
| Authorized Official Name and Position | Kenneth N Sullivan (DIRECTOR RCM) |
| Authorized Official Contact | 6156015250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Bridge Dental Va Pllc Dept Ch 18077 Palatine IL 60055-8077 Ph: (212) 686-3686 | Life Bridge Dental Va Pllc 4201 Wilson Blvd Ste 190 Arlington VA 22203-4147 Ph: (212) 686-3686 |
| NPI Number | 1316603939 |
|---|---|
| Provider Enumeration Date | 11/09/2021 |
| Last Update Date | 11/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316603939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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