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General NPI Number Information
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NPI Number | 1114412848
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Entity Type | Organization
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Legal Business Name | GORGEOUS SMILE PLLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 4001 9TH ST N STE 218
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City | ARLINGTON
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State | VA
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Zip | 22203-1900
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Country | US
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Telephone | 619-278-9239
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Fax |
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Provider Business Mailing Address
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Address Line | 13113 SHADOWBROOK LN
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City | FAIRFAX
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State | VA
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Zip | 22033-5405
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Country | US
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Telephone | 619-278-9239
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AHMED T AL-SALIM
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Credential | DDS
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Telephone | 619-278-9239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | VA
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