| Greater Washington Oral and Maxillofacial Surgery | |
|
4210 Fairfax Corner Ave W Ste 201a Fairfax VA 22030-8619 | |
| (540) 225-2259 | |
| (540) 225-2253 |
| Full Name | Greater Washington Oral and Maxillofacial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4210 Fairfax Corner Ave W Ste 201a, Fairfax, Virginia |
| Authorized Official Name and Position | Paula Kriegh (PRACTICE MANAGER) |
| Authorized Official Contact | 5402252259 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Washington Oral and Maxillofacial Surgery 4210 Fairfax Corner Ave W Ste 201a Fairfax VA 22030-8619 Ph: (540) 225-2259 | Greater Washington Oral and Maxillofacial Surgery 4210 Fairfax Corner Ave W Ste 201a Fairfax VA 22030-8619 Ph: (540) 225-2259 |
| NPI Number | 1396486940 |
|---|---|
| Provider Enumeration Date | 04/06/2022 |
| Last Update Date | 04/06/2022 |
| Certification Date | 04/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396486940 | NPI | - | NPPES |
| 0401414186 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (NU) | Primary |
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