Crystal Smile, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CRYSTAL SMILE, PLLC

Practice address

2611 Jefferson Davis Hwy Ste 200
Arlington, VA 22202-4043

Phone

(571) 295-4200

NPI assigned

Aug 8, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Favagehi, DDS

Title

President

Phone

(703) 356-1200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565222400000",
    "number": "1639724461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8304 OLD COURTHOUSE RD STE C",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823881",
            "telephone_number": "703-356-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 JEFFERSON DAVIS HWY STE 200",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222024043",
            "telephone_number": "571-295-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL SMILE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-08-08",
        "status": "A",
        "authorized_official_last_name": "FAVAGEHI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-356-1200",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0401007352",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Alexandra Cruz Herbas, DDS
• Crystal City Chiropractic
• Crystal City Dental Arts Center
• Crystal City Nursing Center, Inc.
• Crystal Eye Care,Inc
• Gerson J Cuellar, D.D.S.
• Ruben Dario Cuellar, DDS
• Mercedes V Cueva
• Katrina Michelle Cuffey
• Beth B. Cuje, ED.D., LPC, LMFT

• General Practice Dentistry in Arlington, VA
• Providers in Arlington, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.