Healthcare Provider Details

I. General information

NPI: 1316863624
Provider Name (Legal Business Name): KIDS SMILE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 ROUTE 50 STE 503
FAIRFAX VA
22033-3310
US

IV. Provider business mailing address

12011 ROUTE 50 STE 503
FAIRFAX VA
22033-3310
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-5220
  • Fax:
Mailing address:
  • Phone: 703-559-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ZEINA ESTEPHAN
Title or Position: OWNER
Credential: DDS
Phone: 703-559-5220