Healthcare Provider Details

I. General information

NPI: 1093861395
Provider Name (Legal Business Name): NOVA MICROENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 BRANDON AVE 314
SPRINGFIELD VA
22150-2522
US

IV. Provider business mailing address

6120 BRANDON AVE 314
SPRINGFIELD VA
22150-2522
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-0000
  • Fax:
Mailing address:
  • Phone: 703-569-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ANTHONY FABIO
Title or Position: VICEPRESIDENT
Credential: DDS
Phone: 703-569-0000