Provider Demographics
NPI:1144987025
Name:POTOMAC SURGICAL ARTS,PC
Entity type:Organization
Organization Name:POTOMAC SURGICAL ARTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-723-5366
Mailing Address - Street 1:19440 GOLF VISTA PLZ STE 130
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8264
Mailing Address - Country:US
Mailing Address - Phone:571-239-8206
Mailing Address - Fax:
Practice Address - Street 1:19440 GOLF VISTA PLAZA
Practice Address - Street 2:SUITE 130
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8264
Practice Address - Country:US
Practice Address - Phone:703-723-5366
Practice Address - Fax:703-723-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty