| Pediatric And Adolescent Dentistry | |
|
10875 Main St # 105 Fairfax VA 22030 | |
| (703) 352-4121 | |
| (703) 352-4122 |
| Full Name | Pediatric And Adolescent Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 10875 Main St # 105, Fairfax, Virginia |
| Authorized Official Name and Position | Faranak Ghalehbaghi (PEDIATRIC DENTIST) |
| Authorized Official Contact | 7033524121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric And Adolescent Dentistry 10875 Main St # 105 Fairfax VA 22030 Ph: (703) 352-4121 | Pediatric And Adolescent Dentistry 10875 Main St # 105 Fairfax VA 22030 Ph: (703) 352-4121 |
| NPI Number | 1548359649 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548359649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 8254 (Virginia) | Primary |
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