Fairfax Dental Esthetics

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FAIRFAX DENTAL ESTHETICS

Practice address

9621 Fairfax Blvd.
Fairfax, VA 22031

Phone

(703) 279-3400

Fax

(703) 272-7726

NPI assigned

Apr 24, 2019

Last updated

Apr 24, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sanae Bouallali-Berrada

Title

DDS/Owner

Phone

(703) 279-3400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1790349801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9621 FAIRFAX BLVD.",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-279-3400",
            "fax_number": "703-272-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9621 FAIRFAX BLVD.",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-279-3400",
            "fax_number": "703-272-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX DENTAL ESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-24",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "BOUALLALI-BERRADA",
        "authorized_official_first_name": "SANAE",
        "authorized_official_title_or_position": "DDS/OWNER",
        "authorized_official_telephone_number": "703-279-3400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairfax Counseling Services, LLC
• Fairfax County Public School
• Fairfax County, Virginia (Fairfax-Falls Church Community Services Board)
• Fairfax County, Virginia (Fairfax Falls Church Community Services Board - DD Services)
• Fairfax Dental Center
• Fairfax Dental Partners, PC (Nova Dental Partners)
• Fairfax Dentistry, PLLC
• Fairfax Endoscopy Center LLC
• Fairfax Eye Associates Inc
• Fairfax Eye Center, PC

• Dentist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.