Provider Demographics
NPI:1417515180
Name:SMILEVILLE PLLC
Entity Type:Organization
Organization Name:SMILEVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-DOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-237-1700
Mailing Address - Street 1:8223 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6940
Mailing Address - Country:US
Mailing Address - Phone:202-680-0866
Mailing Address - Fax:
Practice Address - Street 1:10009 SOUTHPOINT PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2710
Practice Address - Country:US
Practice Address - Phone:540-237-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780120717Medicaid