Provider Demographics
NPI:1912404559
Name:SMILE EXPERTS
Entity Type:Organization
Organization Name:SMILE EXPERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDLEEB
Authorized Official - Middle Name:REHMAN
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-374-8000
Mailing Address - Street 1:203 YOAKUM PKWY APT 1111
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3731
Mailing Address - Country:US
Mailing Address - Phone:630-877-4989
Mailing Address - Fax:
Practice Address - Street 1:4810 BEAUREGARD ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:571-374-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415413261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental