Fairfax Orthodontic Associates, PLLC
Preferred Provider Organization in Fairfax, VA. Organization (NPI-2).
NPI number1497979504
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1497979504
- Entity type
- Organization (NPI-2)
- Legal business name
- Fairfax Orthodontic Associates, PLLC
- Organization subpart
- No
- Enumeration date
- Apr 12, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305R00000X | Preferred Provider Organization | 0401007980 | VA | Yes |
Practice location
12011 Lee Jackson Memorial HwyFairfax, VA 22033-3310
Phone 703-691-9061
Mailing address
12011 Lee Jackson Memorial HwyFairfax, VA 22033-3310
Phone 703-691-9061
Authorized official
Lucy L. McCabe
Administrator
7037195828
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