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General NPI Number Information
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NPI Number | 1972241081
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Entity Type | Organization
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Legal Business Name | SMILE DENTAL CENTER PLLC
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 14416 JEFFERSON DAVIS HWY STE 16
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City | WOODBRIDGE
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State | VA
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Zip | 22191-2890
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Country | US
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Telephone | 703-492-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 OLD COURTHOUSE RD STE A
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City | VIENNA
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State | VA
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Zip | 22182-3872
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GEITH KALLAS
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Credential |
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Telephone | 703-622-3300
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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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