Healthcare Provider Details

I. General information

NPI: 1285807370
Provider Name (Legal Business Name): MY BRACES DOCTOR, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST #300
FAIRFAX VA
22030-6914
US

IV. Provider business mailing address

10721 MAIN ST #300
FAIRFAX VA
22030-6914
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-6686
  • Fax: 703-277-7674
Mailing address:
  • Phone: 703-591-6686
  • Fax: 703-277-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. NAHID N SINA
Title or Position: PRES
Credential: DMD, MS
Phone: 703-966-7959