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General NPI Number Information
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NPI Number | 1316473937
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Entity Type | Organization
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Legal Business Name | LIFETIME SMILES BURKE
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 5200A ROLLING RD
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City | BURKE
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State | VA
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Zip | 22015-4696
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Country | US
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Telephone | 703-323-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 5200A ROLLING RD
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City | BURKE
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State | VA
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Zip | 22015-4696
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SINA REANGBER
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Credential | DDS
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Telephone | 703-624-5766
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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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