Provider Demographics
NPI:1013342161
Name:VIRGINIA SMILES PLLC
Entity Type:Organization
Organization Name:VIRGINIA SMILES PLLC
Other - Org Name:VIRGINIA SMILES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-291-9699
Mailing Address - Street 1:21001 SYCOLIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4074
Mailing Address - Country:US
Mailing Address - Phone:571-291-9699
Mailing Address - Fax:
Practice Address - Street 1:21001 SYCOLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4074
Practice Address - Country:US
Practice Address - Phone:571-291-9699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20131411OtherLOUDOUN COUNTY BUSINESS TAX A/C NUMBER