| Smileville Pllc | |
|
10009 Southpoint Pkwy Ste 201 Fredericksburg VA 22407-2710 | |
| (540) 237-1700 | |
| Not Available |
| Full Name | Smileville Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10009 Southpoint Pkwy Ste 201, Fredericksburg, Virginia |
| Authorized Official Name and Position | Ali Al-douri (DIRECTOR) |
| Authorized Official Contact | 5402371700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smileville Pllc 8223 Cottage St Vienna VA 22180-6940 Ph: (202) 680-0866 | Smileville Pllc 10009 Southpoint Pkwy Ste 201 Fredericksburg VA 22407-2710 Ph: (540) 237-1700 |
| NPI Number | 1417515180 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 05/29/2019 |
| Medicare PECOS PAC ID | 8820410822 |
|---|---|
| Medicare Enrollment ID | O20200620000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417515180 | NPI | - | NPPES |
| 1780120717 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Ibrahim M Haron |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1871804781 PECOS PAC ID: 7012226392 Enrollment ID: I20200620000035 |
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