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General NPI Number Information
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NPI Number | 1457066292
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Entity Type | Organization
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Legal Business Name | DR TOOTHFAIRY PC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 105 E ANNANDALE RD STE 215
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4422
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Country | US
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Telephone | 703-677-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 105 E ANNANDALE RD STE 215
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4422
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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 | DR. LARA SALEH
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Credential | DDS MS
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Telephone | 810-333-6063
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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 |
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License Number State |
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