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General NPI Number Information
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NPI Number | 1265547947
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Entity Type | Organization
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Legal Business Name | ANH H PHAM DDS & BARRY R MAHARAJ DDS PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 3910 CENTERVILLE RD STE 110
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City | CHANTILLY
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State | VA
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Zip | 20151-3280
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Country | US
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Telephone | 703-668-9494
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Fax | 703-668-9495
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Provider Business Mailing Address
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Address Line | 3910 CENTERVILLE RD STE 110
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City | CHANTILLY
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State | VA
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Zip | 20151-3280
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Country | US
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Telephone | 703-668-9494
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Fax | 703-668-9495
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. KAITI ROSE GRIM
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Credential | CMOM CERT MEDICAL OF
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Telephone | 703-668-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401410305
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401006304
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License Number State | VA
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