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DR JAW PLLC NPI 1396486940


NPI Information

NPI: 1396486940
Provider Name: DR JAW, PLLC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
4210 FAIRFAX CORNER AVE W STE 201A
FAIRFAX, VA
ZIP 22030
Phone: (540) 225-2259
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DR JAW, PLLC is an oral and maxillofacial surgery dentist in Fairfax, VA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR JAW, PLLC NPI is 1396486940. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4210 FAIRFAX CORNER AVE W STE 201A
FAIRFAX, VA
ZIP 22030-619
Phone: (540) 225-2259
Fax: (540) 225-2253

The provider's authorized official is Paula Kriegh .
The authorized official title is Practice Manager and has the following contact phone number (540) 225-2259.

The enumeration date for this NPI number is 4/6/2022 and was last updated on 4/6/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10401414186MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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