|
| |
|
1000 Wilson Blvd Suite M745 Arlington VA 22209 | |
| (703) 527-6453 | |
| (703) 527-8643 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1000 Wilson Blvd, Arlington, Virginia |
| Authorized Official Name and Position | Jason Farr Favagehi (OWNER) |
| Authorized Official Contact | 7033561200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1000 Wilson Blvd Suite M745 Arlington VA 22209 Ph: (703) 527-6453 | 1000 Wilson Blvd Suite M745 Arlington VA 22209 Ph: (703) 527-6453 |
| NPI Number | 1811040561 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811040561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401007352 (Virginia) | Primary |
Gentle Care Dentists Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 901 N Stuart Street, Suite 101, Arlington, VA 22203 Phone: 703-822-5583 | |
Riverside Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3400 S Clark St Ste 105, Arlington, VA 22202 Phone: 703-740-8978 Fax: 571-464-6588 | |