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Contact Information

LAKE RIDGE ENDODONTICS
12510 C LAKE RIDGE DR
WOODBRIDGE, VA22192-2335
 Phone: 703-494-8624
 Fax: 703-497-1258
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for LAKE RIDGE ENDODONTICS

NPI # 1205933405
LBN Legal business name LAKE RIDGE ENDODONTICS
Authorized official TODD WYNKOOP - (OWNER/ENDODOTONTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 09/20/2006
Last updated 07/09/2008 - About 18 years ago
Identifiers
VA License # 041007464
Other 174982 BLUE CROSS BLUE SHIELD
Other 872859 UNITED CONCORDIA
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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