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General NPI Number Information
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NPI Number | 1235245879
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD HEALTHY SMILE
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8338 TRAFORD LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1638
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Country | US
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Telephone | 703-866-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 8338 TRAFORD LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1638
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Country | US
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Telephone | 703-866-7005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARYAM SABA
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Credential | D.D.S.
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Telephone | 703-866-7005
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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 |
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