Provider Demographics
NPI:1326595083
Name:KARIS DENTAL, PLLC
Entity Type:Organization
Organization Name:KARIS DENTAL, PLLC
Other - Org Name:KARIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-853-0415
Mailing Address - Street 1:4290 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8157
Mailing Address - Country:US
Mailing Address - Phone:703-828-6630
Mailing Address - Fax:888-636-8702
Practice Address - Street 1:4290 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE #202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8157
Practice Address - Country:US
Practice Address - Phone:703-828-6630
Practice Address - Fax:888-636-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty