MEDICARE: DR. MICHAEL EDWIN OPPENHEIMER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	6369	VA

General Provider Information

NPI Number	:	1639172620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EDWIN OPPENHEIMER D.M.D.

Provider Business Mailing Address
First Line	:	9938 MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3901
Country	:	US
Telephone Number	:	703-591-6700
Fax Number	:	703-691-0686

Provider Business Practice Location Address
First Line	:	9938 MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3901
Country	:	US
Telephone Number	:	703-591-6700
Fax Number	:	703-691-0686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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