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General NPI Number Information
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NPI Number | 1396486940
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Entity Type | Organization
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Legal Business Name | DR JAW, PLLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 4210 FAIRFAX CORNER AVE W STE 201A
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City | FAIRFAX
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State | VA
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Zip | 22030-8619
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Country | US
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Telephone | 540-225-2259
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Fax | 540-225-2253
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Provider Business Mailing Address
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Address Line | 4210 FAIRFAX CORNER AVE W STE 201A
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City | FAIRFAX
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State | VA
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Zip | 22030-8619
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Country | US
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Telephone | 540-225-2259
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Fax | 540-225-2253
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PAULA KRIEGH
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Credential |
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Telephone | 540-225-2259
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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 |
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License Number State |
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