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General NPI Number Information
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NPI Number | 1659038883
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SMILES OF FAIRFAX, PLLC
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 13135 LEE JACKSON HWY STE 110
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City | FAIRFAX
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State | VA
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Zip | 22033-1909
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Country | US
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Telephone | 908-472-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 12705 THERESA DR
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City | SILVER SPRING
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State | MD
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Zip | 20904-3561
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Country | US
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Telephone | 908-472-5358
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAZMIN FLOYD
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Credential | DMD
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Telephone | 908-472-5358
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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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