Provider Demographics
NPI:1265902407
Name:ISMILE OF MANASSAS PLLC
Entity type:Organization
Organization Name:ISMILE OF MANASSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-409-3893
Mailing Address - Street 1:11700 PLAZA AMERICA DR STE 140
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4753
Mailing Address - Country:US
Mailing Address - Phone:434-409-3893
Mailing Address - Fax:
Practice Address - Street 1:10695 SUDLEY MANOR DR STE 102
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2884
Practice Address - Country:US
Practice Address - Phone:703-369-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental