Organization
PEDIATRIC AND ADOLESCENT DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARANAK GHALEHBAGHI DDS (PEDIATRIC DENTIST)
(703) 352-4121
Entity
Organization
Contact information
Practice address
4605D PINECREST OFFICE PARK DR, ALEXANDRIA, VA 22312-1442
(703) 352-4121
Mailing address
4605D PINECREST OFFICE PARK DR, ALEXANDRIA, VA 22312-1442
(703) 352-4121
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401008254
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548359649
—
VA
05
—
1821308115
—
VA
Enumeration date
12/13/2011
Last updated
12/13/2011
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