Provider Demographics
NPI:1316473937
Name:LIFETIME SMILES BURKE
Entity type:Organization
Organization Name:LIFETIME SMILES BURKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REANGBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-624-5766
Mailing Address - Street 1:5200A ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200A ROLLING RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4696
Practice Address - Country:US
Practice Address - Phone:703-323-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental