# FAIRFAX DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245766484
- **Authorized official:** MRS. JESSICA HAGUE (OFFICE MANAGER)
- **Authorized official phone:** (703) 273-1443

## Contact information

- **Practice address:** 4000 VIRGINIA ST, FAIRFAX, VA 22032-1047
- **Practice address phone:** (703) 273-1443
- **Practice address fax:** (703) 273-9186
- **Mailing address:** 4000 VIRGINIA ST, FAIRFAX, VA 22032-1047
- **Mailing address phone:** (703) 273-1443
- **Mailing address fax:** (703) 273-9186

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401410745 | VA | Yes |

## Other

- **Enumeration date:** 05/09/2017
- **Last updated:** 05/09/2017