Provider Demographics
NPI:1285184036
Name:JUNIOR SMILES OF STAFFORD PLLC
Entity type:Organization
Organization Name:JUNIOR SMILES OF STAFFORD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-699-2441
Mailing Address - Street 1:963 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3906
Mailing Address - Country:US
Mailing Address - Phone:540-699-2441
Mailing Address - Fax:
Practice Address - Street 1:963 GARRISONVILLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3906
Practice Address - Country:US
Practice Address - Phone:540-699-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1447676887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty