Organization
CRYSTAL SMILE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON FAVAGEHI DDS (PRESIDENT)
(703) 356-1200
Entity
Organization
Contact information
Practice address
2611 JEFFERSON DAVIS HWY STE 200, ARLINGTON, VA 22202-4043
(571) 295-4200
Mailing address
8304 OLD COURTHOUSE RD STE C, VIENNA, VA 22182-3881
(703) 356-1200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401007352
LICENSE
VA
Enumeration date
08/08/2019
Last updated
08/08/2019
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