# JASON FARR FAVAGEHI DDS III PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chantilly Dental Arts Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780736355
- **Authorized official:** JASON FARR FAVAGEHI DDS (PRESIDENT)
- **Authorized official phone:** (703) 356-1200

## Contact information

- **Practice address:** 13655 A LEE JACKSON MEM HWY, CHANTILLY, VA 20151
- **Practice address phone:** (703) 263-7222
- **Practice address fax:** (703) 263-2276
- **Mailing address:** 13655 A LEE JACKSON MEM HWY, CHANTILLY, VA 20151
- **Mailing address phone:** (703) 263-7222
- **Mailing address fax:** (703) 263-2276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401007352 | VA | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 08/22/2020