Healthcare Provider Details

I. General information

NPI: 1407449226
Provider Name (Legal Business Name): LET'S SMILE OF LANDMARK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 LITTLE RIVER TPKE
ALEXANDRIA VA
22312-1714
US

IV. Provider business mailing address

6204 LITTLE RIVER TPKE
ALEXANDRIA VA
22312-1714
US

V. Phone/Fax

Practice location:
  • Phone: 703-658-3000
  • Fax:
Mailing address:
  • Phone: 703-658-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI YOUSEF GHATRI
Title or Position: OWNER
Credential: DDS
Phone: 703-658-3000