Provider Demographics
NPI:1942660873
Name:SMILES 4 FAIRFAX, PLC
Entity Type:Organization
Organization Name:SMILES 4 FAIRFAX, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:THE
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-865-6677
Mailing Address - Street 1:11351 RANDOM HILLS RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6081
Mailing Address - Country:US
Mailing Address - Phone:703-865-6677
Mailing Address - Fax:703-865-6680
Practice Address - Street 1:11351 RANDOM HILLS RD
Practice Address - Street 2:SUITE 290
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6081
Practice Address - Country:US
Practice Address - Phone:703-865-6677
Practice Address - Fax:703-865-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118361223G0001X
VA04014143831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty