Healthcare Provider Details

I. General information

NPI: 1245948140
Provider Name (Legal Business Name): FALLS CHURCH SMILE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LITTLE FALLS ST STE 101
FALLS CHURCH VA
22046-4302
US

IV. Provider business mailing address

200 LITTLE FALLS ST STE 101
FALLS CHURCH VA
22046-4302
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-7725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J PAESANI
Title or Position: OWNER
Credential:
Phone: 703-237-7725