Healthcare Provider Details

I. General information

NPI: 1386660769
Provider Name (Legal Business Name): MALA ANN BRITTO D.D.S., M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LAFAYETTE CENTER DR SUITE 160B
CHANTILLY VA
20151-1247
US

IV. Provider business mailing address

4080 LAFAYETTE CENTER DR SUITE 160B
CHANTILLY VA
20151-1247
US

V. Phone/Fax

Practice location:
  • Phone: 703-230-1000
  • Fax: 703-230-0509
Mailing address:
  • Phone: 703-230-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: