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General NPI Number Information
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NPI Number | 1497075220
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Entity Type | Organization
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Legal Business Name | OASIS PEDIATRIC DENTAL CARE, PC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 800 W BROAD ST SUITE 307
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3142
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Country | US
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Telephone | 703-854-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W BROAD ST SUITE 307
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3142
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Country | US
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Telephone | 703-854-1710
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. NATHALIE PHAETON
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Credential | DDS
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Telephone | 703-854-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401411508
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License Number State | VA
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