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General NPI Number Information
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NPI Number | 1831360536
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Entity Type | Organization
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Legal Business Name | MALA A BRITTO DDS PC
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 4080 LAFAYETTE CENTER DR STE 160B
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City | CHANTILLY
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State | VA
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Zip | 20151-1247
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Country | US
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Telephone | 703-230-1000
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Fax | 703-230-0509
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Provider Business Mailing Address
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Address Line | 4080 LAFAYETTE CENTER DR STE 160B
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City | CHANTILLY
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State | VA
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Zip | 20151-1247
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Country | US
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Telephone | 703-230-1000
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Fax | 703-230-0509
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALA A BRITTO
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Credential | DDS
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Telephone | 703-230-1000
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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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