Provider Demographics
NPI:1831360536
Name:MALA A BRITTO DDS PC
Entity type:Organization
Organization Name:MALA A BRITTO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-230-1000
Mailing Address - Street 1:4080 LAFAYETTE CENTER DR STE 160B
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1247
Mailing Address - Country:US
Mailing Address - Phone:703-230-1000
Mailing Address - Fax:703-230-0509
Practice Address - Street 1:4080 LAFAYETTE CENTER DR STE 160B
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1247
Practice Address - Country:US
Practice Address - Phone:703-230-1000
Practice Address - Fax:703-230-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180684Medicaid