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General NPI Number Information
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NPI Number | 1194219139
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Entity Type | Organization
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Legal Business Name | SMILE STUDIO SPECIALIST INC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 7787 LEESBURG PIKE # 200
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2412
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Country | US
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Telephone | 703-982-2222
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Fax | 703-982-2223
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Provider Business Mailing Address
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Address Line | 7787 LEESBURG PIKE # 200
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2412
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Country | US
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Telephone | 703-982-2222
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Fax | 703-982-2223
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Authorized Official
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Title or Position | OWNER
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Name | ELI JANABI
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Credential |
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Telephone | 919-665-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401415327
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License Number State | VA
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