Organization
FAIRFAX DENTAL ESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANAE BOUALLALI-BERRADA (DDS/OWNER)
(703) 279-3400
Entity
Organization
Contact information
Practice address
9621 FAIRFAX BLVD., FAIRFAX, VA 22031
(703) 279-3400
(703) 272-7726
Mailing address
9621 FAIRFAX BLVD., FAIRFAX, VA 22031
(703) 279-3400
(703) 272-7726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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