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General NPI Number Information
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NPI Number | 1891201802
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Entity Type | Organization
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Legal Business Name | ORAL AND FACIAL SURGERY CENTER OF VIRGINIA
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 3787 FETTLER PARK DR STE A8
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City | DUMFRIES
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State | VA
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Zip | 22025-1946
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Country | US
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Telephone | 857-247-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 3887 FAIRFAX RIDGE RD APT 313
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City | FAIRFAX
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State | VA
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Zip | 22030-7544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HASNAIN SHINWARI
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Credential | DDS
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Telephone | 857-247-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401415066
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 0438000358
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License Number State | VA
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