Healthcare Provider Details

I. General information

NPI: 1154106052
Provider Name (Legal Business Name): BRIGHTER SMILE FAMILY DENTISTRY AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46400 BENEDICT DR STE 109
STERLING VA
20164-6605
US

IV. Provider business mailing address

46400 BENEDICT DR STE 109
STERLING VA
20164-6605
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-3412
  • Fax:
Mailing address:
  • Phone: 703-444-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ZAHRA KAVIANPOUR
Title or Position: DENTIST
Credential: DDS
Phone: 703-444-3412