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General NPI Number Information
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NPI Number | 1952125981
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Entity Type | Organization
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Legal Business Name | OPAL DENTAL BOUTIQUE PLLC DBA ATELIER OPAL DENTAL
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 2700 S QUINCY ST STE 215
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City | ARLINGTON
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State | VA
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Zip | 22206-2242
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Country | US
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Telephone | 571-429-4416
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Fax | 571-429-4418
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Provider Business Mailing Address
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Address Line | 750 THORNTON WAY APT 415
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4393
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Country | US
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Telephone | 571-338-9726
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SMAIYRA CHAUDHARY
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Credential | DDS
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Telephone | 571-429-4416
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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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