Provider Demographics
NPI:1598044760
Name:SMILE DENTAL CLINIC
Entity Type:Organization
Organization Name:SMILE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-379-1900
Mailing Address - Street 1:5645 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2867
Mailing Address - Country:US
Mailing Address - Phone:703-379-1900
Mailing Address - Fax:703-671-6338
Practice Address - Street 1:5645 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2867
Practice Address - Country:US
Practice Address - Phone:703-379-1900
Practice Address - Fax:703-671-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078851223G0001X
VA04014126871223G0001X
VA04014126011223G0001X
VA04014125061223G0001X
VA04014119081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty