Provider Demographics
NPI:1245531805
Name:DR. MALA BRITTO'S CHILDREN'S DENTISTRY
Entity type:Organization
Organization Name:DR. MALA BRITTO'S CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MALA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:703-670-1991
Mailing Address - Street 1:12581 MILSTEAD WAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5445
Mailing Address - Country:US
Mailing Address - Phone:703-670-1991
Mailing Address - Fax:
Practice Address - Street 1:12581 MILSTEAD WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5445
Practice Address - Country:US
Practice Address - Phone:703-670-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MALA A. BRITTO'S CHILDREN'S DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty