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General NPI Number Information
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NPI Number | 1245531805
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Entity Type | Organization
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Legal Business Name | DR. MALA BRITTO'S CHILDREN'S DENTISTRY
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 12581 MILSTEAD WAY SUITE 305
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5445
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Country | US
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Telephone | 703-670-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 12581 MILSTEAD WAY SUITE 305
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5445
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Country | US
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Telephone | 703-670-1991
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. MALA ANN BRITTO
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Credential | DDS, MS
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Telephone | 703-670-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401410545
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License Number State | VA
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