MEDICARE: OPAL DENTAL BOUTIQUE PLLC DBA ATELIER OPAL DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1952125981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPAL DENTAL BOUTIQUE PLLC DBA ATELIER OPAL DENTAL

Provider Business Mailing Address
First Line	:	750 THORNTON WAY APT 415
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4393
Country	:	US
Telephone Number	:	571-338-9726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 S QUINCY ST STE 215
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2242
Country	:	US
Telephone Number	:	571-429-4416
Fax Number	:	571-429-4418

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SMAIYRA CHAUDHARY
Credential	:	DDS
Telephone Number	:	571-429-4416

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	01/28/2026

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