# CRYSTAL CITY DENTAL ARTS CENTER

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

## Provider details

- **NPI number:** 1932467180
- **Authorized official:** DR. JASON FAVAGEHI DDS (PRESIDENT)
- **Authorized official phone:** (703) 356-1200

## Contact information

- **Practice address:** 1615-E CRYSTAL SQUARE ARCADE, ARLINGTON, VA 22202
- **Practice address phone:** (202) 599-9100
- **Mailing address:** 8304-C OLD COURTHOUSE RD., VIENNA, VA 22182
- **Mailing address phone:** (703) 356-1200
- **Mailing address fax:** (703) 356-6742

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401007352 | VA | Yes |

## Other

- **Enumeration date:** 04/25/2012
- **Last updated:** 04/25/2012