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General NPI Number Information
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NPI Number | 1205788239
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL SMILES PLLC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 11077 MARSH RD STE A
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City | BEALETON
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State | VA
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Zip | 22712-5639
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Country | US
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Telephone | 571-284-6424
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Fax | 571-636-1333
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Provider Business Mailing Address
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Address Line | 11077 MARSH RD STE A
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City | BEALETON
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State | VA
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Zip | 22712-5639
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Country | US
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Telephone | 571-284-6424
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Fax | 571-636-1333
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MALIK USMAN
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Credential | DDS
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Telephone | 774-208-4431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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