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General NPI Number Information
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NPI Number | 1285891911
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Entity Type | Organization
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Legal Business Name | FAIRFAX SMILES DENTAL CARE PLC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 3930 PENDER DR SUITE110
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 703-359-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 PENDER DR SUITE110
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 703-359-9080
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. VLADIMIR SOYFER
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Credential | DMD PHD JD
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Telephone | 703-359-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401410407
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401410407
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License Number State | VA
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