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General NPI Number Information
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NPI Number | 1417515180
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Entity Type | Organization
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Legal Business Name | SMILEVILLE PLLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 10009 SOUTHPOINT PKWY STE 201
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-2710
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Country | US
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Telephone | 540-237-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 8223 COTTAGE ST
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City | VIENNA
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State | VA
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Zip | 22180-6940
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Country | US
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Telephone | 202-680-0866
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALI AL-DOURI
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Credential | DDS
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Telephone | 540-237-1700
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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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