Provider Demographics
NPI:1902049372
Name:ELITE SMILES DENTAL
Entity Type:Organization
Organization Name:ELITE SMILES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-771-9494
Mailing Address - Street 1:552 FORT EVANS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4098
Mailing Address - Country:US
Mailing Address - Phone:703-771-9494
Mailing Address - Fax:703-771-9340
Practice Address - Street 1:552 FORT EVANS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4098
Practice Address - Country:US
Practice Address - Phone:703-771-9494
Practice Address - Fax:703-771-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty