Provider Demographics
NPI:1144854936
Name:SMILEZ PEDIATRIC DENTAL GROUP OF LOUDOUN PLLC
Entity type:Organization
Organization Name:SMILEZ PEDIATRIC DENTAL GROUP OF LOUDOUN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EL AOMARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-542-7300
Mailing Address - Street 1:24565 DULLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2715
Mailing Address - Country:US
Mailing Address - Phone:703-542-7300
Mailing Address - Fax:
Practice Address - Street 1:24565 DULLES LANDING DR
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2715
Practice Address - Country:US
Practice Address - Phone:703-542-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty