| NPI | 1932760196 |
|---|---|
| Doing Business As | DULLES LIFE SMILES |
| Entity Type | Organization |
| Authorized Contact | GINO OSCAR VALDIVIESO CHIANG Owner 571-210-0435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-06-27 |