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General NPI Number Information
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NPI Number | 1629754726
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Entity Type | Organization
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Legal Business Name | FAIRFAX DENTAL PARTNERS, PC
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 10529 BRADDOCK RD STE A
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City | FAIRFAX
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State | VA
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Zip | 22032-2245
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Country | US
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Telephone | 703-250-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 10529 BRADDOCK RD STE A
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City | FAIRFAX
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State | VA
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Zip | 22032-2245
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Country | US
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Telephone | 703-250-2970
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. DANA MARIE COLASANTO
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Credential |
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Telephone | 571-331-5619
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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 |
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License Number State |
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