Provider Demographics
NPI:1043808702
Name:PEDIATRIC DENTAL SPECIALISTS OF LOUDOUN PLLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS OF LOUDOUN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BITA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:LUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-559-4889
Mailing Address - Street 1:20 PIDGEON HILL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6154
Mailing Address - Country:US
Mailing Address - Phone:703-444-5337
Mailing Address - Fax:
Practice Address - Street 1:20 PIDGEON HILL DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6154
Practice Address - Country:US
Practice Address - Phone:703-444-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty