# CRYSTAL SMILE, PLLC

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

## Provider details

- **NPI number:** 1639724461
- **Authorized official:** JASON FAVAGEHI DDS (PRESIDENT)
- **Authorized official phone:** (703) 356-1200

## Contact information

- **Practice address:** 2611 JEFFERSON DAVIS HWY STE 200, ARLINGTON, VA 22202-4043
- **Practice address phone:** (571) 295-4200
- **Mailing address:** 8304 OLD COURTHOUSE RD STE C, VIENNA, VA 22182-3881
- **Mailing address phone:** (703) 356-1200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/08/2019
- **Last updated:** 08/08/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0401007352 | LICENSE | VA |