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General NPI Number Information
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NPI Number | 1952961971
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Entity Type | Organization
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Legal Business Name | SMILE CONCEPT PLLC
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 7857 HERITAGE DR STE 320
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City | ANNANDALE
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State | VA
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Zip | 22003-5350
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Country | US
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Telephone | 703-721-4261
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Fax | 703-782-8347
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Provider Business Mailing Address
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Address Line | 7857 HERITAGE DR STE 320
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City | ANNANDALE
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State | VA
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Zip | 22003-5350
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Country | US
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Telephone | 703-721-4261
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Fax | 703-782-8347
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Authorized Official
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Title or Position | OWNER
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Name | DR. MONICA ELIANA CHANG
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Credential | D.D.S
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Telephone | 703-721-4261
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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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