# FAIRFAXDENTALGROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POTOMAC VALLEY DENTAL CARE PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073986568
- **Legal business name:** POTOMAC VALLEY DENTAL CARE PLLC
- **Authorized official:** DR. MICHAEL GORMAN DDS (DENTIST/OWNER)
- **Authorized official phone:** (703) 830-9110

## Contact information

- **Practice address:** 8316 ARLINGTON BLVD, FAIRFAX, VA 22031-5207
- **Practice address phone:** (703) 560-6301
- **Practice address fax:** (703) 560-1334
- **Mailing address:** 8316 ARLINGTON BLVD, FAIRFAX, VA 22031-5207
- **Mailing address phone:** (703) 560-6301
- **Mailing address fax:** (703) 560-1334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2015
- **Last updated:** 11/05/2015