FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC NPI 1710907134

NPI Information

FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC 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. FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC NPI is 1710907134. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10530 ROSEHAVEN ST
SUITE 111
FAIRFAX, VA
ZIP 22030-840
Phone: (703) 385-5777
Fax: (703) 591-5386

The provider's authorized official is Julia M Spradlin .
The authorized official title is Administrator and has the following contact phone number (703) 385-5777.

The CLIA number assigned to this NPI record is 49D1101653 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/20/2006 and was last updated on 4/27/2009.

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:

Other Identifiers

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