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General NPI Number Information
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NPI Number | 1942660873
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Entity Type | Organization
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Legal Business Name | SMILES 4 FAIRFAX, PLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 11351 RANDOM HILLS RD SUITE 290
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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 | 703-865-6680
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Provider Business Mailing Address
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Address Line | 11351 RANDOM HILLS RD SUITE 290
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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 | 703-865-6680
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | HOWARD THE NGO
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Credential |
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Telephone | 703-865-6677
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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 | 0401414383
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401411836
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License Number State | VA
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