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General NPI Number Information
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NPI Number | 1699348920
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Entity Type | Organization
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Legal Business Name | NOVA SMILE DESIGN PLLC
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 11351 RANDOM HILLS RD
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City | FAIRFAX
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State | VA
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Zip | 22030-6081
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Country | US
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Telephone | 703-865-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 805 GOLDEN ARROW ST
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City | GREAT FALLS
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State | VA
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Zip | 22066-2517
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Country | US
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Telephone | 202-256-5396
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Fax |
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | SYLVIE M LAM
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Credential | DDS
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Telephone | 202-256-5396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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