Healthcare Provider Details

I. General information

NPI: 1962693051
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES OF NORTHERN VIRGINIA, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WHITING ST SUITE 106
ALEXANDRIA VA
22304-3418
US

IV. Provider business mailing address

101 S WHITING ST SUITE 106
ALEXANDRIA VA
22304-3418
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-7841
  • Fax:
Mailing address:
  • Phone: 703-751-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401006414
License Number StateVA

VIII. Authorized Official

Name: DR. JAMES ALBERT PELL
Title or Position: PRESIDENT
Credential: DDS
Phone: 703-751-7841