Healthcare Provider Details

I. General information

NPI: 1508022567
Provider Name (Legal Business Name): PLEASANT VALLEY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LAFAYETTE CENTER DR STE 160-A
CHANTILLY VA
20151-1247
US

IV. Provider business mailing address

4080 LAFAYETTE CENTER DR STE 160-A
CHANTILLY VA
20151-1247
US

V. Phone/Fax

Practice location:
  • Phone: 703-230-6784
  • Fax: 703-230-0509
Mailing address:
  • Phone: 703-230-6784
  • Fax: 703-230-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401008946
License Number StateVA

VIII. Authorized Official

Name: DR. AJIT DENIS BRITTO
Title or Position: OWNER/DOCTOR
Credential: DDS MSD
Phone: 703-230-6784