Provider Demographics
NPI:1821849498
Name:SPLENDID SMILES PLLC
Entity Type:Organization
Organization Name:SPLENDID SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-680-4880
Mailing Address - Street 1:15 CUMMINGS DR APT 302
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7173
Mailing Address - Country:US
Mailing Address - Phone:732-208-4696
Mailing Address - Fax:
Practice Address - Street 1:571 FROST AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3023
Practice Address - Country:US
Practice Address - Phone:540-680-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty