MEDICARE: THE DENTIST OFFICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401410237	VA

General Provider Information

NPI Number	:	1083029557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTIST OFFICE PC

Provider Business Mailing Address
First Line	:	8808F PEAR TREE VILLAGE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4221
Country	:	US
Telephone Number	:	703-499-9006
Fax Number	:	703-441-7927

Provider Business Practice Location Address
First Line	:	8808F PEAR TREE VILLAGE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4221
Country	:	US
Telephone Number	:	703-499-9006
Fax Number	:	703-441-7927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR O FALAIYE
Credential	:	DMD
Telephone Number	:	703-336-7098

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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