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General NPI Number Information
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NPI Number | 1538749908
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Entity Type | Organization
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Legal Business Name | SMILEON DENTISTRY PLLC
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Dates
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Enumeration Date | 04/10/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 5742 PICKWICK RD
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City | CENTREVILLE
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State | VA
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Zip | 20121-4730
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Country | US
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Telephone | 703-543-8112
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Fax | 703-825-1644
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Provider Business Mailing Address
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Address Line | 5742 PICKWICK RD
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City | CENTREVILLE
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State | VA
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Zip | 20121-4730
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Country | US
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Telephone | 703-543-8112
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Fax | 703-825-1644
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROHINI BANAVAR
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Credential | DMD
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Telephone | 703-543-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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