Provider Demographics
NPI:1235503764
Name:FAISAL MIR, DDS, PLLC
Entity Type:Organization
Organization Name:FAISAL MIR, DDS, PLLC
Other - Org Name:SMILE DENTAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-234-8998
Mailing Address - Street 1:2200 COLUMBIA PIKE
Mailing Address - Street 2:APT 710
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4432
Mailing Address - Country:US
Mailing Address - Phone:571-278-7070
Mailing Address - Fax:
Practice Address - Street 1:2108 18TH ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1891
Practice Address - Country:US
Practice Address - Phone:202-234-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1952701476Medicaid