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Organization

CRYSTAL CITY DENTAL ARTS CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JASON FAVAGEHI DDS (PRESIDENT)
(703) 356-1200
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007352
VA

Other

Enumeration date
04/25/2012
Last updated
04/25/2012
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