| NPI | 1932467180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON FAVAGEHI President 703-356-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007352) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |