Lake Manassa Dental Center

NPI #1356539100 in Gainesville, Virginia

Provider Information

NPI Number: 1356539100
Entity Type: Organization
Organization Name: Lake Manassa Dental Center
Primary Specialty: Dentist
Enumeration Date: Oct 5, 2007
Last Updated: Oct 5, 2007

Practice Location

Address: 7915 LAKE MANASSAS DR
Address 2: STE 115
City: Gainesville
State: Virginia
ZIP Code: 20155
Phone: (646) 641-8825

Authorized Official

Name: LONG NGUYEN, D.D.S.
Title: MEMBER
Phone: (646) 641-8825

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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