# GENERAL AND COSMETIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093154106
- **Authorized official:** DR. GEITH J KALLAS (PRESIDENT)
- **Authorized official phone:** (703) 356-0250

## Contact information

- **Practice address:** 8310 OLD COURTHOUSE RD STE A, VIENNA, VA 22182-3872
- **Practice address phone:** (703) 356-0250
- **Practice address fax:** (703) 356-9430
- **Mailing address:** 8310 OLD COURTHOUSE RD STE A, VIENNA, VA 22182-3872
- **Mailing address phone:** (703) 356-0250
- **Mailing address fax:** (703) 356-9430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401008829 | VA | Yes |

## Other

- **Enumeration date:** 06/21/2013
- **Last updated:** 06/21/2013