# FARANAK GHALEHBAGHI PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric and Adolescent Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548359649
- **Authorized official:** MS. FARANAK GHALEHBAGHI DDS (PEDIATRIC DENTIST)
- **Authorized official phone:** (703) 352-4121

## Contact information

- **Practice address:** 10875 MAIN ST \# 105, FAIRFAX, VA 22030
- **Practice address phone:** (703) 352-4121
- **Practice address fax:** (703) 352-4122
- **Mailing address:** 10875 MAIN ST \# 105, FAIRFAX, VA 22030
- **Mailing address phone:** (703) 352-4121
- **Mailing address fax:** (703) 352-4122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 8254 | VA | Yes |

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 08/22/2020