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General NPI Number Information
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NPI Number | 1316237225
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Entity Type | Organization
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Legal Business Name | LANSDOWNE SMILE DESINE
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 19450 DEERFIELD AVE STE 465
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City | LANSDOWNE
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State | VA
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Zip | 20176-6822
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Country | US
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Telephone | 703-724-4220
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Fax | 703-724-1910
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Provider Business Mailing Address
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Address Line | 19450 DEERFIELD AVE STE 465
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City | LANSDOWNE
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State | VA
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Zip | 20176-6822
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Country | US
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Telephone | 703-724-4220
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Fax | 703-724-1910
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. AMIRREZA RAFAAT
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Credential | D.D.S.,PC
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Telephone | 703-724-4220
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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 | 0401410532
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License Number State | VA
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