# ANH H PHAM DDS & BARRY R MAHARAJ DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chantilly Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265547947
- **Authorized official:** MRS. KAITI ROSE GRIM CMOM CERT MEDICAL OF (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (703) 668-9494

## Contact information

- **Practice address:** 3910 CENTERVILLE RD, STE 110, CHANTILLY, VA 20151-3280
- **Practice address phone:** (703) 668-9494
- **Practice address fax:** (703) 668-9495
- **Mailing address:** 3910 CENTERVILLE RD, STE 110, CHANTILLY, VA 20151-3280
- **Mailing address phone:** (703) 668-9494
- **Mailing address fax:** (703) 668-9495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401006304 | VA | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401410305 | VA | — |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 06/27/2013