Fairfax Dental Esthetics

NPI #1790349801 in Fairfax, Virginia

Provider Information

NPI Number: 1790349801
Entity Type: Organization
Organization Name: Fairfax Dental Esthetics
Primary Specialty: Dentist
Enumeration Date: Apr 24, 2019
Last Updated: Apr 24, 2019

Practice Location

Address: 9621 FAIRFAX BLVD.
City: Fairfax
State: Virginia
ZIP Code: 22031
Phone: (703) 279-3400

Authorized Official

Name: SANAE BOUALLALI-BERRADA
Title: DDS/OWNER
Phone: (703) 279-3400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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