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General NPI Number Information
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NPI Number | 1629467881
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Entity Type | Organization
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Legal Business Name | GREAT SMILE DENTAL
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 900 N RANDOLPH ST SUITE #103
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City | ARLINGTON
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State | VA
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Zip | 22203-1949
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Country | US
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Telephone | 703-243-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N RANDOLPH ST SUITE #103
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City | ARLINGTON
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State | VA
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Zip | 22203-1949
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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 | PRESIDENT
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Name | DR. HOMAN SOLEMANINEJAD
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Credential |
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Telephone | 703-862-5824
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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 | 0401410638
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License Number State | VA
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