Healthcare Provider Details

I. General information

NPI: 1831526995
Provider Name (Legal Business Name): NORTHERN VIRGINIA ORAL AND FACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 FAIRFAX CORNER AVE E STE 235
FAIRFAX VA
22030-8623
US

IV. Provider business mailing address

4211 FAIRFAX CORNER AVE E SUITE 235
FAIRFAX VA
22030-8622
US

V. Phone/Fax

Practice location:
  • Phone: 703-449-8888
  • Fax: 703-449-9888
Mailing address:
  • Phone: 703-449-8888
  • Fax: 703-449-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number0401413939
License Number StateVA

VIII. Authorized Official

Name: DR. HUY TRINH
Title or Position: DIRECTOR
Credential: DDS
Phone: 703-449-8888