| Pediatric And Adolescent Dentistry Pc | |
|
4605d Pinecrest Office Park Dr Alexandria VA 22312-1442 | |
| (703) 352-4121 | |
| Not Available |
| Full Name | Pediatric And Adolescent Dentistry Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4605d Pinecrest Office Park Dr, Alexandria, 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 Pc 4605d Pinecrest Office Park Dr Alexandria VA 22312-1442 Ph: (703) 352-4121 | Pediatric And Adolescent Dentistry Pc 4605d Pinecrest Office Park Dr Alexandria VA 22312-1442 Ph: (703) 352-4121 |
| NPI Number | 1558639906 |
|---|---|
| Provider Enumeration Date | 12/13/2011 |
| Last Update Date | 12/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558639906 | NPI | - | NPPES |
| 1821308115 | Medicaid | VA | |
| 1548359649 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 0401008254 (Virginia) | Primary |
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