Provider Demographics
NPI:1629467881
Name:GREAT SMILE DENTAL
Entity Type:Organization
Organization Name:GREAT SMILE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEMANINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-862-5824
Mailing Address - Street 1:900 N RANDOLPH ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 N RANDOLPH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1949
Practice Address - Country:US
Practice Address - Phone:703-243-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410638261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental