Healthcare Provider Details

I. General information

NPI: 1124693882
Provider Name (Legal Business Name): METROPOLITAN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 LEE HWY STE 450
FAIRFAX VA
22031-4488
US

IV. Provider business mailing address

8315 LEE HWY STE 450
FAIRFAX VA
22031-4488
US

V. Phone/Fax

Practice location:
  • Phone: 703-260-7895
  • Fax:
Mailing address:
  • Phone: 703-260-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN NELSON
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 703-260-7895