Individual
HAFSA IJAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 PAYNE ST STE 101, FALLS CHURCH, VA 22041-2313
(703) 763-5697
Mailing address
22678 FLOWING SPRING SQ, BRAMBLETON, VA 20148-4891
(571) 623-5488
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401417720
VA
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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