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General NPI Number Information
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NPI Number | 1255103602
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Entity Type | Organization
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Legal Business Name | THOMAS G VACCARO DDS,PC
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 11130 FAIRFAX BLVD STE 201
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City | FAIRFAX
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State | VA
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Zip | 22030-5035
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Country | US
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Telephone | 703-591-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 11130 FAIRFAX BLVD STE 201
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City | FAIRFAX
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State | VA
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Zip | 22030-5035
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS GERARD VACCARO
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Credential |
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Telephone | 703-591-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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