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General NPI Number Information
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NPI Number | 1982293064
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Entity Type | Organization
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Legal Business Name | SMILE DOCTORS ORTHODONTICS OF VIRGINIA PC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 22855 BRAMBLETON PLZ STE 200
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City | BRAMBLETON
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State | VA
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Zip | 20148-4871
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Country | US
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Telephone | 703-574-2174
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674509
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City | DALLAS
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State | TX
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Zip | 75267-4509
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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 | CHIEF CLINICAL OFFICER
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Name | SCOTT LAW
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Credential |
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Telephone | 386-264-3925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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