# NOVA PERIO SPECIALISTS

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

## Provider details

- **NPI number:** 1205407467
- **Authorized official:** CRYSTAL SPARKS (MANAGER)
- **Authorized official phone:** (703) 444-4377

## Contact information

- **Practice address:** 21165 WHITFIELD PL STE 107, STERLING, VA 20165-7276
- **Practice address phone:** (703) 444-4377
- **Practice address fax:** (703) 444-7383
- **Mailing address:** 21165 WHITFIELD PL STE 107, STERLING, VA 20165-7276
- **Mailing address phone:** (703) 444-4377
- **Mailing address fax:** (703) 444-7383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/08/2021
- **Last updated:** 06/08/2022