# BOULEVARD DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dr Ricardo M Gaitan DDS/PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639346182
- **Authorized official:** DR. RICARDO MOISES GAITAN DDS/PC (GENERAL DENTIST)
- **Authorized official phone:** (703) 206-0466

## Contact information

- **Practice address:** 8301 ARLINGTON BLVD, SUITE \#403, FAIRFAX, VA 22031-2902
- **Practice address phone:** (703) 206-0466
- **Practice address fax:** (703) 206-0479
- **Mailing address:** 8301 ARLINGTON BLVD, SUITE \#403, FAIRFAX, VA 22031-2902
- **Mailing address phone:** (703) 206-0466
- **Mailing address fax:** (703) 206-0479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401008771 | VA | Yes |

## Other

- **Enumeration date:** 05/14/2008
- **Last updated:** 05/14/2008