Provider Demographics
NPI:1538749908
Name:SMILEON DENTISTRY PLLC
Entity type:Organization
Organization Name:SMILEON DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-543-8112
Mailing Address - Street 1:5742 PICKWICK RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4730
Mailing Address - Country:US
Mailing Address - Phone:703-543-8112
Mailing Address - Fax:703-825-1644
Practice Address - Street 1:5742 PICKWICK RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4730
Practice Address - Country:US
Practice Address - Phone:703-543-8112
Practice Address - Fax:703-825-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty