Healthcare Provider Details

I. General information

NPI: 1639596612
Provider Name (Legal Business Name): JOSHUA FEIN, DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 HAMAKER CT STE 320
FAIRFAX VA
22031-2304
US

IV. Provider business mailing address

3025 HAMAKER CT STE 320
FAIRFAX VA
22031-2304
US

V. Phone/Fax

Practice location:
  • Phone: 703-539-0400
  • Fax: 703-539-0445
Mailing address:
  • Phone: 703-539-0400
  • Fax: 703-539-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401412567
License Number StateVA

VIII. Authorized Official

Name: DR. JOSHUA EVAN FEIN
Title or Position: PRESIDENT, ENDODONTIST
Credential: DDS, MS
Phone: 703-539-0400