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General NPI Number Information
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NPI Number | 1902360068
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Entity Type | Organization
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Legal Business Name | FAIRFAX ADVANCED DENTISTRY, P.C.
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 3930 PENDER DR STE 150
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City | FAIRFAX
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State | VA
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Zip | 22030-0986
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Country | US
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Telephone | 703-650-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 PENDER DR STE 150
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City | FAIRFAX
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State | VA
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Zip | 22030-0986
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Country | US
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Telephone | 703-650-9299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEX OSINOVSKY
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Credential |
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Telephone | 703-861-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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